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CARDIOVASCULAR ANESTHESIA

Blood-Transfusion Requirements and Blood Salvage in Donors Undergoing Right Hepatectomy for Living Related Liver Transplantation

Jürgen T. Lutz, MD, DEAA^*, Camino Valentín-Gamazo, MD, Klaus Görlinger, MD^*, Massimo Malagó, MD, and Jürgen Peters, MD^*

Klinik für *Anästhesiologie und Intensivmedizin, und Allgemein- und Transplantationschirurgie, Universitätsklinikum Essen, Essen, Germany

Address correspondence and reprint requests to Dr. med. Jürgen T. Lutz, DEAA, Klinik für Anästhesiologie und Intensivmedizin, Universitätsklinikum Essen, Hufelandstr. 55, D-45133 Essen, FRG. Address e-mail to juergen.lutz{at}uni-essen.de

Living related liver donation for liver transplantation in adults including its risks is receiving increased attention. We present data from 44 liver donors focusing on transfusion requirements and avoidance of heterologous transfusion. The volume of blood transfused (both autologous from preoperative donation and heterologous) was assessed including that derived from intraoperative isovolemic hemodilution, cell-saver salvaged, and retransfused blood. Hemoglobin concentration and central venous pressure were measured at specified time points before and during surgery. Intraoperative blood loss was calculated and correlated to the duration of parenchymal transsection, liver volume resected, and central venous pressure. There were no specific anesthesia-evoked complications. In 4 donors, major bleeding (>2000 mL) occurred. Blood loss averaged 902 ± 564 mL (SD), yielding a minimal mean hemoglobin concentration of 8.1 ± 1.2 g/dL. One donor received 3 U of heterologous blood and 30 donors received autologous blood from their preoperative donation. An average of 592 ± 112 mL of blood derived from perioperative acute isovolemic hemodilution was retransfused as was 421 ± 333 mL of washed red cells from the cell-saving system. Avoidance of heterologous blood transfusion, application of blood-saving techniques, and efficient pain management are crucial for adult living liver donors. Transfusion of banked blood can be avoided in most patients when intraoperative cell salvage, preoperative autologous blood donation, and intraoperative hemodilution are combined.

IMPLICATIONS: Avoidance of heterogenous blood transfusion in the donor operation for living donor liver transplantation is crucial. We describe our experience with the first 44 liver donors under special consideration of state-of-the-art blood-saving techniques applied.

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				B. Gali, J. Y. Findlay, D. J. Plevak, C. B. Rosen, R. Dierkhising, and D. M. Nagorney Right Hepatectomy for Living Liver Donation vs Right Hepatectomy for Disease: Intraoperative and Immediate Postoperative Comparison Arch Surg, May 1, 2007; 142(5): 467 - 472. [Abstract] [Full Text] [PDF]

				F. Takaoka, A. Teruya, P. Massarollo, S. Mies, J. T. Lutz, K. Gorlinger, J. Peters, C. Valentin-Gamazo, and M. Malago Minimizing Risks for Donors Undergoing Right Hepatectomy for Living-Related Liver Transplantation * Response Anesth. Analg., July 1, 2003; 97(1): 297 - 298. [Full Text] [PDF]