Perioperative normovolemic anemia is safe in pediatric living-donor liver transplantation

Perioperative normovolemic anemia was applied in pediatric living-donor liver transplant (LDLT) recipients with the aim of reducing the use of blood products and decreasing transfusion-related risk. The anemic state was allowed to occur by replacing intraoperative blood and transudate loss with colloid solutions and a discriminate use of packed red blood cells. When blood transfusion was required, the amount of blood replacement was calculated to target a hemoglobin level not higher than 8 to 9 g/dL. Forty-eight pediatric patients underwent LDLT. Their mean hemoglobin and hematocrit levels were maintained below 9 g/dL and 27%, respectively, at the end of the operation, at the time of extubation, postoperative days 3, 10, and 20, and at the time of discharge. The mean ventilatory support time was 15.7 hr, and no patient required reintubation. Graft function normalized within the first week posttransplant in all patients, and there was no documented case of acute hepatic artery thrombosis. All the patients were discharged with acceptable liver function, and 98% of them remain alive to date. Routine application of perioperative normovolemic anemia in pediatric LDLT has allowed the sparing use of blood products. Approximately half of our patients (42%) did not require intraoperative blood transfusion; 31% of the patients went home without receiving any blood products except 5% albumin. There were no adverse effects with this maneuver, and graft function was good in all patients.