FRESH FROZEN PLASMA IN ORTHOTOPIC LIVER TRANSPLANT: FRIEND OF FOE?

•Traditionally, large volumes of fresh frozen plasma (FFP) were required to correct altered conventional coagulation test in patients with end-stage liver disease.•Hydric overload caused by FFP may lead to a worsen of bleeding and, therefore, a higher transfusion requirement. This leads to an increase in hospital stay and patient morbidity.•The aim of this study is to determine the morbidity associated to the use of FFP in the intraoperative period of patients undergoing orthotopic liver transplantation. Traditionally, the administration of large volume of Fresh Frozen Plasma (FFP) was common during liver transplant surgery, with no improvement in the results in terms of bleeding and blood saving. Moreover, this hydric overload caused by FFP may be harmful, leading to an increase in hospital stay and patient's morbidity. The objective is to assess the morbidity associated to the use of FFP in the intraoperative period of patients undergoing orthotopic liver transplantation. The study design is an observational retrospective study, collecting data of the transplanted patient from 2010 to 2020. Acute renal failure was more frequent in the group that received FFP than in the group that did not, with a statistical difference (p = .0017). We did not find any statistical difference between the groups in terms of pulmonary complications and graft-associated thromboembolic events Transfusion of FFP requires large volumes to achieve a relevant elevation of coagulation factors. This hydric overload could justify the high incidence of renal complications found. Prothrombin Complex could be an interesting alternative to FFP. Fibrinogen as first-line therapy could correct perioperative bleeding and reduce the use of FFP.