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Blood Management in the Liver Transplant Patient

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Essentials of Blood Product Management in Anesthesia Practice

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Abstract

Hemostatic management for liver transplantation requires understanding the changes in physiology and coagulation status of patients with end stage liver disease. In addition, it requires anticipation of the surgical stages and their hemodynamic and metabolic effects. Although standard laboratory testing may indicate a bleeding risk, clinical evidence and point of care viscoelastic testing show that a balanced decrease in synthesis of pro- and anti-coagulant factors in patients with end stage liver disease generally results in a state of relative homeostasis termed “rebalanced hemostasis.” However, this balance is fragile and places patients at risk of developing either hypo- or hyper-coagulable states which may lead to bleeding or thrombosis. Anatomical complexity secondary to portal hypertension also contributes to the increased risk of hemorrhage during transplant. Several different products and blood management techniques may be useful to help control commonly faced hemostatic problems during liver transplantation.

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Authors and Affiliations

  1. The Icahn School of Medicine at Mount Sinai Hospital, Department of Anesthesiology, Perioperative and Pain Management, New York, NY, USA

    Diana Romano, Jeron Zerillo & Natalie Smith

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  1. Diana Romano
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  2. Jeron Zerillo
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  3. Natalie Smith
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Correspondence to Diana Romano .

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Editors and Affiliations

  1. NYU-Grossman School of Medicine, Department of Anesthesiology, New York, NY, USA

    Corey S. Scher

  2. Departments of Anesthesiology and Pharmacology Toxicology, and Neurosciences, Louisiana State University School of Medicine-Shreveport, Shreveport, LA, USA

    Alan David Kaye

  3. Department of Anesthesiology and Perioperative Medicine, Milton S. Hershey Medical Center, Penn State College of Medicine, Hershey, PA, USA

    Henry Liu

  4. NYU Grossman School of Medicine, Department of Anesthesiology, Perioperative Care and Pain Medicine, New York, NY, USA

    Seth Perelman

  5. NYU-Grossman School of Medicine, Department of Anesthesiology, New York, NY, USA

    Sarah Leavitt

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Romano, D., Zerillo, J., Smith, N. (2021). Blood Management in the Liver Transplant Patient. In: Scher, C.S., Kaye, A.D., Liu, H., Perelman, S., Leavitt, S. (eds) Essentials of Blood Product Management in Anesthesia Practice. Springer, Cham. https://doi.org/10.1007/978-3-030-59295-0_25

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