Impact of hemostasis and blood loss on outcome after liver surgery

Liver surgery is a relatively young surgical specialty. The first anatomical right hemihepatectomy was described in 1952, the first successful liver transplantation in 1968. The liver is a densely vascularized organ, and is the producer of the majority of coagulation factors. Partial resection or transplantation of the liver can result in major blood loss, for which blood transfusion may be necessary. Ongoing improvements in surgical and anesthesiological techniques have led to a significant improvement in outcome, and an increase in number of liver resections and transplantations. Despite these improvements, even nowadays blood loss and blood transfusions remain independent risk factors for outcome after liver resection and transplantation.
We analyzed the use and efficacy of hemostatic agents in liver resections. According to a survey among Dutch surgeons, topical hemostatic agents are frequently used not only to improve intraoperative hemostasis, but also with the aim to reduce postoperative resection surface-related complications, such as bile leakage. However, results from a multicenter randomized trial showed that application of fibrin sealant, a hemostatic glue, at the resection surface of the liver did not lead to a reduction in the incidence of postoperative bile leakage.
Furthermore we assessed the impact of transfusion of various blood products on outcome after liver transplantation. The proportion of patients receiving transfusion of any blood component decreased from 100% in the period 1989-1996 to 74% in the period 1997-2004. This study showed that in addition to red blood cell transfusions, platelet transfusions have a negative impact on survival after liver transplantation.