Management of coagulopathy and hemorrhage during orthotopic liver transplantation

Management of coagulopathy and hemorrhage during orthotopic liver transplantation Orthotopic liver transplantation concerns patients with acute or chronic liver failure. Liver disease is responsible of haemostatic disorders: primary and secondary haemostasis and fibrinolysis. This results in a rebalanced haemostasis in cirrhotic patients. During the different steps of transplantation procedure coagulation defects appear, associated with bleeding, hardly predictable. Prophylactic correction of biologic disturbances can no more be recommended if no bleeding is associated. Per operative blood salvage and retransfusion is safe. Transfusion of homologous blood products has negative side effects. The role of point-of-care coagulation devices has to be determined. Further studies are warranted to elaborate recommendations for the management of coagulopathy and hemorrhage during liver transplantation.