Fluids administration and coagulation characteristics in patients with different model for end-stage liver disease scores undergoing orthotopic liver transplantation

Background There have been many studies investigating the impact of the model for end-stage liver disease(MELD)score on predicting post-transplant outcome.But it is unclear whether MELD is correlated to intraoperative fluid therapyand coagulation status.We investigated the relationship between the severity of liver diseases as measured by MELDscore and intraoperative fluid requirements and the changes of coagulation characteristics.Methods Ninety patients were included in this retrospective study.The patients were stratified into three groupsaccording to the MELD scores:<15(low),15-25(medium)and>25(high).Intraoperatively,volume was restored withallogeneic and/or salvaged red blood cells(RBC),fresh-frozen plasma(FFP),platelet and other types of fluids accordingto hemodynamic data,hematocrit,and clotting data.Intraoperative coagulation data,blood requirements and other fluidsadministered were compared among the 3 groups.Results Before surgery,in addition to the three variables used to calculate MELD scores in other baseline laboratoryvalues,including ratio of activated partial thromboplastin time(R-APTT),D-Dimer,hematocrit,platelet and blood ureanitrogen(BUN)were significantly different among the 3 groups.The blood loss increased with increasing MELD.Thevolume of RBC(allogeneinc,salvaged and total),FFP,platelet and the total volume of transfusion were also significantlydifferent among the three groups(P<0.01).The requirements for prothrombin complex and fibrinogen showed a similarpattern.During operation,the changing trends of each coagulation variable were different.Compared with baseline,during each intraoperative stage,INR and R-APPT increased in the low MELD group.While in the medium MELD andhigh MELD groups,INR did not changed significantly during the operation,and R-APPT significantly increased only afterrepeffusion.Conclusions This study provided some useful information for perioperative management of patients undergoing livertransplantation.Careful preoperative planning and resource preparation are crucial for patients with high MELD scores.Close communication between surgeon,anesthesiologist and the transfusion staff of blood bank before and duringsurgery should be stressed.