Comparison of the Effect of two Strategies of Fluid Management on Blood Loss and Transfusion Requirement During Liver Transplantation

Objective to compare the effect of low central venous pressure (LCVP) and transesophageal Doppler (TED) guided fluid management on blood loss and blood transfusion during liver transplantation (LTx). Design retrospective study Setting single–institutional, university hospital Participants Adult recipients of LTx Interventions Two groups. Control (LCVP G), n=45 with CVP was maintained 40% lower than the preoperative value during the preanhepatic phase. The mean arterial pressure was kept >60 mm Hg. This group was matched with the second group (TED G); n=45, in which a TED protocol was followed with maintaining the systemic vascular resistance (SVR) more than 750dyns-1 secm-5 . Coagulation defects were corrected following thromboelastometry. Measurements and Main Results Intraoperative blood loss, blood products, perioperative creatinine, lactate and postoperative patients’ stratification according to AKIN classification were compared. Prior the anhepatic phase, CVP was significantly lower in LCVP G (p < 0.001). TED G tended to have less, but non-significant; blood loss, packed red blood cells (RBCs), fresh frozen plasma (FFP) and platelets and received significantly less colloid and higher norepinephrine. Lactate was significantly higher in LCVP G at the end of the anhepatic phase and end of surgery while, urine output in the preanhepatic phase was significantly lower. Creatinine was significantly lower on postoperative day 1, and 3 and AKIN stages were better in POD1 in TED G. Conclusions During LTx, TED guided fluid management, with norepinephrine used to maintain SVR, was similar to LCVP regarding blood loss and transfusion requirements and has better impacts on Kidney function and lactate.