Anaesthesia III: Coagulation - iltseducation.com

69 Pages·2005·1.79 MB·English

International Course in Anaesthesia and
Critical Care
for Liver Transplantation
26 – 27th May 2005, Newcastle upon Tyne
Anaesthesia III: Coagulation
Sue Mallett, Consultant Anaesthetist, Royal Free Hospital

Monitoring & Treatment of Coagulopathy in OLT
Bleeding & Liver Transplantation
Early transplants in 1980’s associated with high
(cid:132)
blood loss: average 25-30 units per case
Transfusion of over 100 units not exceptional
(cid:132)
Direct relationship between units transfused and
(cid:132)
patient outcome and graft survival
Red Cell Transfusion: OLT
Late 1980’s average
(cid:132)
RBC transfusion
45
around 25 units
40
35
C
B 30 Late 1990’s average
(cid:132)
R
25
f
o RBC transfusion
20
s
t
i 15
n
fallen to 4 units
U
10
5
0
85 87 89 91 93 95 97
Year
2005: Liver Transplantation & Bleeding
Average RBC transfusion fallen
(cid:132)
2 – 4 units
(cid:132)
Increasing number of OLT with no
(cid:132)
perioperative transfusion: 20 – 50%
5 – 10% > 10 units
(cid:132)
Transfusion in Liver Transplantation
Massicotte L et al. Anesth Analg 2004;98:1245-51
What has made the difference?
Surgical technique & experience
(cid:132)
Perioperative management
(cid:132)
Graft preservation
(cid:132)
Coagulation monitoring & treatment
(cid:132)
Marked inter-institutional variability
(cid:132)
Experience, attitude, skills
(cid:132)
institutional practice
(cid:132)
Transfusion Predictors
Year of transplantation
(cid:132)
Surgical factors
(cid:132)
Previous upper abdominal surgery
(cid:132)
Technique
(cid:132)
Duration of surgery
(cid:132)
Cold ischaemia time
(cid:132)
Medical factors
(cid:132)
Aetiology of liver disease
(cid:132)
Pugh Classification / MELD score
(cid:132)
Baseline Hb, INR, platelet count
(cid:132)
Transfusion in OLT
12
10
8
Units of RBC Cirrhosis 1980's
6
transfused
Cirrhosis 1990's
4
2
0
Dissection Anhepatic Reperfusion ITU