Decreasing blood product requirements after orthotopic liver transplantation.

OBJECTIVES: To document the changing blood product transfusion requirements over time during the first 50 orthotopic liver transplantation (OLT) operations performed at Groote Schuur Hospital. DESIGN: The first 50 OLT operations were divided into three groups chronologically and blood transfusion requirements were compared across the three groups. SETTING: Groote Schuur Hospital, Cape Town. SUBJECTS: Forty-seven patients undergoing 50 OLT operations between October 1988 and September 1999. The majority of patients had end-stage chronic liver disease. Patients were divided chronologically into three groups of 16, 17 and 17 patients. OUTCOME MEASURES: The number of units of blood products transfused in each group was quantified. RESULTS: During the study period there was a significant decrease in the number of units of packed red cells, fresh frozen plasma (FFP) and platelets (but not cryoprecipitate) transfused intraoperatively. The median number of units of packed cells decreased from 13.5 in our first 16 patients (group 1) to 5.0 in our last 17 (group 3). The median number of units of platelets transfused was 9 in group 1 and 0 in groups 2 and 3. No platelets were transfused in our last 22 patients. The average cost of blood products transfused intraoperatively per patient in the three groups decreased from R13 034 in group 1 to R11 389 in group 2 to R7 396 in group 3. CONCLUSION: The number of units of blood products transfused during OLT operations has decreased since the programme started 13 years ago. The reasons include increased experience, the use of aprotinin to block fibrinolysis and the selective use of the thromboelastogram to monitor coagulation intraoperatively. OLT need no longer be regarded as wasteful of blood resources. Use of platelets to treat thrombocytopenia need not be empirical.