Red blood cell transfusion in liver resection

  • Nicholas Latchana
  • Dhruvin H. Hirpara
  • Julie Hallet
  • Paul J. KaranicolasEmail author



Several modalities exist for the management of hepatic neoplasms. Resection, the most effective approach, carries significant risk of hemorrhage. Blood loss may be corrected with red blood cell transfusion (RBCT) in the short term, but may ultimately contribute to negative outcomes.


Using available literature, we seek to define the frequency and risk factors of blood loss and transfusion following hepatectomy. The impact of blood loss and RBCT on short- and long-term outcomes is explored with an emphasis on peri-operative methods to reduce hemorrhage and transfusion.


Following hepatic surgery, 25.2–56.8% of patients receive RBCT. Patients who receive RBCT are at increased risk of surgical morbidity in a dose-dependent manner. The relationship between blood transfusion and surgical mortality is less apparent. RBCT might also impact long-term oncologic outcomes including disease recurrence and overall survival. Risk factors for bleeding and blood transfusion include hemoglobin concentration < 12.5 g/dL, thrombocytopenia, pre-operative biliary drainage, presence of background liver disease (such as cirrhosis), coronary artery disease, male gender, tumor characteristics (type, size, location, presence of vascular involvement), extent of hepatectomy, concomitant extrahepatic organ resection, and operative time. Strategies to mitigate blood loss or transfusion include pre-operative (iron, erythropoietin), intra-operative (vascular occlusion, parenchymal transection techniques, hemostatic agents, antifibrinolytics, low central pressure, hemodilution, autologous blood recycling), and post-operative (normothermia, correction of coagulopathy, optimization of nutrition, restrictive transfusion strategy) methods.


Blood loss during hepatectomy is common and several risk factors can be identified pre-operatively. Blood loss and RBCT during hepatectomy is associated with post-operative morbidity and mortality. Disease-free recurrence, disease-specific survival, and overall survival may be associated with blood loss and RBCT during hepatectomy. Attention to pre-operative, intra-operative, and post-operative strategies to reduce blood loss and RBCT is necessary.


Liver Cancer Hemorrhage Transfusion 


Compliance with ethical standards

Conflict of interest

Dr. Karanicolas holds a research grant from Baxter to study Hemopatch in patients undergoing distal pancreatectomy and has received speaker honoraria from Sanofi. Dr. Hallet has received speaking honoraria from Ipsen Biopharmaceuticals Canada and Novartis Oncology. Dr. Latchana and Hirpara have nothing to disclose.

Ethical approval

This article does not contain any studies with human participants performed by any of the authors.


  1. 1.
    McColl RJ, Brar B, Ghali WA, Dixon E (2009) Hepatic resection in Canada: rates and geographic variation. Can J Surg 52(6):E264–E268PubMedPubMedCentralGoogle Scholar
  2. 2.
    Machado MA, Makdissi FF, Surjan RC (2012) Laparoscopic liver resection: personal experience with 107 cases. Rev Col Bras Cir 39(6):483–488PubMedCrossRefPubMedCentralGoogle Scholar
  3. 3.
    Kneuertz PJ, Pitt HA, Bilimoria KY, Smiley JP, Cohen ME, Ko CY, Pawlik TM (2012) Risk of morbidity and mortality following hepato-pancreato-biliary surgery. J Gastrointest Surg 16(9):1727–1735PubMedCrossRefPubMedCentralGoogle Scholar
  4. 4.
    Kim Y, Spolverato G, Lucas DJ, Ejaz A, Xu L, Wagner D, Frank SM, Pawlik TM (2015) Red cell transfusion triggers and postoperative outcomes after major surgery. J Gastrointest Surg 19(11):2062–2073PubMedCrossRefPubMedCentralGoogle Scholar
  5. 5.
    Kuduvalli M, Oo AY, Newall N, Grayson AD, Jackson M, Desmond MJ et al (2005) Effect of peri-operative red blood cell transfusion on 30-day and 1-year mortality following coronary artery bypass surgery. Eur J Cardiothorac Surg 27(4):592–598PubMedCrossRefPubMedCentralGoogle Scholar
  6. 6.
    Burrows L, Tartter P (1982) Effect of blood transfusions on colonic malignancy recurrent rate. Lancet 2(8299):662PubMedCrossRefPubMedCentralGoogle Scholar
  7. 7.
    Carson JL, Terrin ML, Noveck H, Sanders DW, Chaitman BR, Rhoads GG, Nemo G, Dragert K, Beaupre L, Hildebrand K, Macaulay W, Lewis C, Cook DR, Dobbin G, Zakriya KJ, Apple FS, Horney RA, Magaziner J, FOCUS Investigators (2011) Liberal or restrictive transfusion in high-risk patients after hip surgery. N Engl J Med 365(26):2453–2462PubMedPubMedCentralCrossRefGoogle Scholar
  8. 8.
    Hajjar LA, Vincent JL, Galas FR, Nakamura RE, Silva CM, Santos MH et al (2010) Transfusion requirements after cardiac surgery: the TRACS randomized controlled trial. JAMA 304(14):1559–1567PubMedCrossRefPubMedCentralGoogle Scholar
  9. 9.
    Ejaz A, Frank SM, Spolverato G, Kim Y, Pawlik TM (2015) Potential economic impact of using a restrictive transfusion trigger among patients undergoing major abdominal surgery. JAMA Surg 150(7):625–630PubMedCrossRefPubMedCentralGoogle Scholar
  10. 10.
    Bennett S, Baker LK, Martel G, Shorr R, Pawlik TM, Tinmouth A, McIsaac DI, Hébert PC, Karanicolas PJ, McIntyre L, Turgeon AF, Barkun J, Fergusson D (2017) The impact of perioperative red blood cell transfusions in patients undergoing liver resection: a systematic review. HPB (Oxford) 19(4):321–330CrossRefGoogle Scholar
  11. 11.
    Marwah S, Khan MM, Chaudhary A, Gupta S, Negi SS, Soin A et al (2007) Two hundred and forty-one consecutive liver resections: an experience from India. HPB (Oxford) 9(1):29–36CrossRefGoogle Scholar
  12. 12.
    Hallet J, Mahar AL, Nathens AB, Tsang ME, Beyfuss KA, Lin Y, Coburn NG, Karanicolas PJ (2018) The impact of perioperative blood transfusions on short-term outcomes following hepatectomy. Hepatobiliary Surg Nutr 7(1):1–10PubMedPubMedCentralCrossRefGoogle Scholar
  13. 13.
    Jarnagin WR, Gonen M, Fong Y, DeMatteo RP, Ben-Porat L, Little S et al (2002) Improvement in perioperative outcome after hepatic resection: analysis of 1,803 consecutive cases over the past decade. Ann Surg 236(4):397–406 discussion −7PubMedPubMedCentralCrossRefGoogle Scholar
  14. 14.
    Weiss A, Anderson JE, Chang DC (2015) Comparing the national surgical quality improvement program with the nationwide inpatient sample database. JAMA Surg 150(8):815–816PubMedCrossRefPubMedCentralGoogle Scholar
  15. 15.
    Vamvakas EC, Blajchman MA (2007) Transfusion-related immunomodulation (TRIM): an update. Blood Rev 21(6):327–348PubMedCrossRefPubMedCentralGoogle Scholar
  16. 16.
    Kooby DA, Stockman J, Ben-Porat L, Gonen M, Jarnagin WR, Dematteo RP, Tuorto S, Wuest D, Blumgart LH, Fong Y (2003) Influence of transfusions on perioperative and long-term outcome in patients following hepatic resection for colorectal metastases. Ann Surg 237(6):860–869 discussion 9-70PubMedPubMedCentralGoogle Scholar
  17. 17.
    Kuroda S, Tashiro H, Kobayashi T, Oshita A, Amano H, Ohdan H (2012) No impact of perioperative blood transfusion on recurrence of hepatocellular carcinoma after hepatectomy. World J Surg 36(3):651–658PubMedCrossRefPubMedCentralGoogle Scholar
  18. 18.
    Gozzetti G, Mazziotti A, Grazi GL, Jovine E, Gallucci A, Gruttadauria S, Frena A, Morganti M, Ercolani G, Masetti M, Pierangeli F (1995) Liver resection without blood transfusion. Br J Surg 82(8):1105–1110PubMedCrossRefPubMedCentralGoogle Scholar
  19. 19.
    Ejaz A, Spolverato G, Kim Y, Margonis GA, Gupta R, Amini N, Frank SM, Pawlik TM (2015) Impact of blood transfusions and transfusion practices on long-term outcome following hepatopancreaticobiliary surgery. J Gastrointest Surg 19(5):887–896PubMedCrossRefPubMedCentralGoogle Scholar
  20. 20.
    Katz SC, Shia J, Liau KH, Gonen M, Ruo L, Jarnagin WR, Fong Y, DʼAngelica MI, Blumgart LH, DeMatteo RP (2009) Operative blood loss independently predicts recurrence and survival after resection of hepatocellular carcinoma. Ann Surg 249(4):617–623PubMedCrossRefPubMedCentralGoogle Scholar
  21. 21.
    Hallet J, Tsang M, Cheng ES, Habashi R, Kulyk I, Hanna SS et al (2015) The impact of perioperative red blood cell transfusions on long-term outcomes after hepatectomy for colorectal liver metastases. Ann Surg Oncol 22(12):4038–4045PubMedCrossRefPubMedCentralGoogle Scholar
  22. 22.
    Chen JS, Huang JQ, Chen XL, Zhan GF, Feng JT (2015) Risk factors associated with intraoperative major blood loss during resection of hepatocellular carcinoma. Hepato-Gastroenterology 62(140):790–793PubMedPubMedCentralGoogle Scholar
  23. 23.
    Sirichindakul B, Chanwat R, Nonthasoot B, Suphapol J, Nivatvongs S (2005) Risk factors associated with major intraoperative blood loss in hepatic resection for hepatobiliary tumor. J Med Assoc Thail 88(Suppl 4):S54–S58Google Scholar
  24. 24.
    Shirabe K, Kajiyama K, Harimoto N, Tsujita E, Wakiyama S, Maehara Y (2010) Risk factors for massive bleeding during major hepatectomy. World J Surg 34(7):1555–1562PubMedCrossRefPubMedCentralGoogle Scholar
  25. 25.
    Helling TS, Blondeau B, Wittek BJ (2004) Perioperative factors and outcome associated with massive blood loss during major liver resections. HPB (Oxford) 6(3):181–185CrossRefGoogle Scholar
  26. 26.
    Cockbain AJ, Masudi T, Lodge JP, Toogood GJ, Prasad KR (2010) Predictors of blood transfusion requirement in elective liver resection. HPB (Oxford) 12(1):50–55CrossRefGoogle Scholar
  27. 27.
    Pulitanò C, Arru M, Bellio L, Rossini S, Ferla G, Aldrighetti L (2007) A risk score for predicting perioperative blood transfusion in liver surgery. Br J Surg 94(7):860–865PubMedCrossRefPubMedCentralGoogle Scholar
  28. 28.
    Sima CS, Jarnagin WR, Fong Y, Elkin E, Fischer M, Wuest D, D’Angelica M, DeMatteo RP, Blumgart LH, Gönen M (2009) Predicting the risk of perioperative transfusion for patients undergoing elective hepatectomy. Ann Surg 250(6):914–921PubMedCrossRefPubMedCentralGoogle Scholar
  29. 29.
    Lemke M, Law CH, Li J, Dixon E, Tun Abraham M, Hernandez Alejandro R et al (2017) Three-point transfusion risk score in hepatectomy. Br J Surg 104(4):434–442PubMedCrossRefPubMedCentralGoogle Scholar
  30. 30.
    Lemke M, Mahar A, Karanicolas PJ, Coburn NG, Law CHL, Hallet J (2018) Three point transfusion risk score in hepatectomy: an external validation using the American College of Surgeons-National Surgical Quality Improvement Program (ACS-NSQIP). HPB (Oxford) 20(7):669–675CrossRefGoogle Scholar
  31. 31.
    Freedman J, Luke K, Escobar M, Vernich L, Chiavetta JA (2008) Experience of a network of transfusion coordinators for blood conservation (Ontario Transfusion Coordinators [ONTraC]). Transfusion 48(2):237–250PubMedPubMedCentralGoogle Scholar
  32. 32.
    Froman JP, Mathiason MA, Kallies KJ, Bottner WA, Shapiro SB (2012) The impact of an integrated transfusion reduction initiative in patients undergoing resection for colorectal cancer. Am J Surg 204(6):944–950 discussion 50-1PubMedCrossRefPubMedCentralGoogle Scholar
  33. 33.
    LaPar DJ, Crosby IK, Ailawadi G, Ad N, Choi E, Spiess BD et al (2013) Blood product conservation is associated with improved outcomes and reduced costs after cardiac surgery. J Thorac Cardiovasc Surg 145(3):796–803 discussion −4PubMedCrossRefPubMedCentralGoogle Scholar
  34. 34.
    Clevenger B, Mallett SV, Klein AA, Richards T (2015) Patient blood management to reduce surgical risk. Br J Surg 102(11):1325–1337 discussion 4PubMedCrossRefPubMedCentralGoogle Scholar
  35. 35.
    Hallet J, Jayaraman S, Martel H, Ouellet J, Lin Y, McCluskey S et al (2018) Patient blood management for liver resection: consensus statements using Delphi methodology. HPB (Oxford).
  36. 36.
    Marwell JG, Heflin MT, McDonald SR (2018) Preoperative screening. Clin Geriatr Med 34(1):95–105PubMedCrossRefPubMedCentralGoogle Scholar
  37. 37.
    Gupta PK, Sundaram A, Mactaggart JN, Johanning JM, Gupta H, Fang X et al (2013) Preoperative anemia is an independent predictor of postoperative mortality and adverse cardiac events in elderly patients undergoing elective vascular operations. Ann Surg 258(6):1096–1102PubMedCrossRefPubMedCentralGoogle Scholar
  38. 38.
    Muñoz M, deficiency pfticsop-omoai (2017) Peri-operative correction of non-anaemic iron deficiency. A reply. Anaesthesia 72(7):911–2Google Scholar
  39. 39.
    Yohanathan L, Coburn NG, McLeod RS, Kagedan DJ, Pearsall E, Zih FS et al (2016) Understanding perioperative transfusion practices in gastrointestinal surgery—a practice survey of general surgeons. J Gastrointest Surg 20(6):1106–1122PubMedCrossRefPubMedCentralGoogle Scholar
  40. 40.
    Schröder O, Mickisch O, Seidler U, de Weerth A, Dignass AU, Herfarth H et al (2005) Intravenous iron sucrose versus oral iron supplementation for the treatment of iron deficiency anemia in patients with inflammatory bowel disease—a randomized, controlled, open-label, multicenter study. Am J Gastroenterol 100(11):2503–2509PubMedCrossRefPubMedCentralGoogle Scholar
  41. 41.
    Froessler B, Palm P, Weber I, Hodyl NA, Singh R, Murphy EM (2018) The important role for intravenous iron in perioperative patient blood management in major abdominal surgery: a randomized controlled trial. Ann Surg 267(2):e39–e40PubMedCrossRefPubMedCentralGoogle Scholar
  42. 42.
    Kosmadakis N, Messaris E, Maris A, Katsaragakis S, Leandros E, Konstadoulakis MM, Androulakis G (2003) Perioperative erythropoietin administration in patients with gastrointestinal tract cancer: prospective randomized double-blind study. Ann Surg 237(3):417–421PubMedPubMedCentralGoogle Scholar
  43. 43.
    Devon KM, McLeod RS (2009) Pre and peri-operative erythropoietin for reducing allogeneic blood transfusions in colorectal cancer surgery. Cochrane Database Syst Rev 1:CD007148Google Scholar
  44. 44.
    Bennett S, Tinmouth A, McIsaac DI, English S, Hébert PC, Karanicolas PJ et al (2018) Ottawa criteria for appropriate transfusions in hepatectomy: using the RAND/UCLA appropriateness method. Ann Surg 267(4):766–774PubMedCrossRefPubMedCentralGoogle Scholar
  45. 45.
    Pringle JH (1908) V. Notes on the arrest of hepatic hemorrhage due to trauma. Ann Surg 48(4):541–549PubMedPubMedCentralCrossRefGoogle Scholar
  46. 46.
    Petrowsky H, McCormack L, Trujillo M, Selzner M, Jochum W, Clavien PA (2006) A prospective, randomized, controlled trial comparing intermittent portal triad clamping versus ischemic preconditioning with continuous clamping for major liver resection. Ann Surg 244(6):921–928 discussion 8-30PubMedPubMedCentralCrossRefGoogle Scholar
  47. 47.
    Eeson G, Karanicolas PJ (2016) Hemostasis and hepatic surgery. Surg Clin North Am 96(2):219–228PubMedCrossRefPubMedCentralGoogle Scholar
  48. 48.
    Tsang ME, Karanicolas PJ, Habashi R, Cheng E, Hanna SS, Coburn NG, Law CHL, Hallet J (2015) The impact of portal pedicle clamping on survival from colorectal liver metastases in the contemporary era of liver resection: a matched cohort study. HPB (Oxford) 17(9):796–803CrossRefGoogle Scholar
  49. 49.
    Gurusamy KS, Kumar Y, Ramamoorthy R, Sharma D, Davidson BR (2009) Vascular occlusion for elective liver resections. Cochrane Database Syst Rev 1:CD007530Google Scholar
  50. 50.
    Huguet C, Nordlinger B, Galopin JJ, Bloch P, Gallot D (1978) Normothermic hepatic vascular exclusion for extensive hepatectomy. Surg Gynecol Obstet 147(5):689–693PubMedPubMedCentralGoogle Scholar
  51. 51.
    Belghiti J, Noun R, Zante E, Ballet T, Sauvanet A (1996) Portal triad clamping or hepatic vascular exclusion for major liver resection. A controlled study. Ann Surg 224(2):155–161PubMedPubMedCentralCrossRefGoogle Scholar
  52. 52.
    Smyrniotis VE, Kostopanagiotou GG, Contis JC, Farantos CI, Voros DC, Kannas DC, Koskinas JS (2003) Selective hepatic vascular exclusion versus Pringle maneuver in major liver resections: prospective study. World J Surg 27(7):765–769PubMedCrossRefPubMedCentralGoogle Scholar
  53. 53.
    Moggia E, Rouse B, Simillis C, Li T, Vaughan J, Davidson BR et al (2016) Methods to decrease blood loss during liver resection: a network meta-analysis. Cochrane Database Syst Rev 10:CD010683PubMedPubMedCentralGoogle Scholar
  54. 54.
    Lin TY (1973) Results in 107 hepatic lobectomies with a preliminary report on the use of a clamp to reduce blood loss. Ann Surg 177(4):413–421PubMedPubMedCentralCrossRefGoogle Scholar
  55. 55.
    Pachter HL, Spencer FC, Hofstetter SR, Coppa GF (1983) Experience with the finger fracture technique to achieve intra-hepatic hemostasis in 75 patients with severe injuries of the liver. Ann Surg 197(6):771–778PubMedPubMedCentralCrossRefGoogle Scholar
  56. 56.
    Smyrniotis V, Arkadopoulos N, Kostopanagiotou G, Farantos C, Vassiliou J, Contis J, Karvouni E (2005) Sharp liver transection versus clamp crushing technique in liver resections: a prospective study. Surgery 137(3):306–311PubMedCrossRefPubMedCentralGoogle Scholar
  57. 57.
    Lesurtel M, Selzner M, Petrowsky H, McCormack L, Clavien PA (2005) How should transection of the liver be performed?: a prospective randomized study in 100 consecutive patients: comparing four different transection strategies. Ann Surg 242(6):814–822 discussion 22-3PubMedPubMedCentralCrossRefGoogle Scholar
  58. 58.
    Takayama T, Makuuchi M, Kubota K, Harihara Y, Hui AM, Sano K, Ijichi M, Hasegawa K (2001) Randomized comparison of ultrasonic vs clamp transection of the liver. Arch Surg 136(8):922–928PubMedCrossRefPubMedCentralGoogle Scholar
  59. 59.
    Gurusamy KS, Pamecha V, Sharma D, Davidson BR (2009) Techniques for liver parenchymal transection in liver resection. Cochrane Database Syst Rev 1:CD006880Google Scholar
  60. 60.
    Li M, Zhang W, Li Y, Li P, Li J, Gong J, Chen Y (2013) Radiofrequency-assisted versus clamp-crushing parenchyma transection in cirrhotic patients with hepatocellular carcinoma: a randomized clinical trial. Dig Dis Sci 58(3):835–840PubMedCrossRefPubMedCentralGoogle Scholar
  61. 61.
    Ikeda M, Hasegawa K, Sano K, Imamura H, Beck Y, Sugawara Y, Kokudo N, Makuuchi M (2009) The vessel sealing system (LigaSure) in hepatic resection: a randomized controlled trial. Ann Surg 250(2):199–203PubMedCrossRefPubMedCentralGoogle Scholar
  62. 62.
    Schemmer P, Friess H, Dervenis C, Schmidt J, Weitz J, Uhl W, Büchler MW (2007) The use of endo-GIA vascular staplers in liver surgery and their potential benefit: a review. Dig Surg 24(4):300–305PubMedCrossRefPubMedCentralGoogle Scholar
  63. 63.
    Kakaei F, Seyyed Sadeghi MS, Sanei B, Hashemzadeh S, Habibzadeh A (2013) A randomized clinical trial comparing the effect of different haemostatic agents for haemostasis of the liver after hepatic resection. HPB Surg 2013:587608PubMedPubMedCentralCrossRefGoogle Scholar
  64. 64.
    Fischer L, Seiler CM, Broelsch CE, de Hemptinne B, Klempnauer J, Mischinger HJ, Gassel HJ, Rokkjaer M, Schauer R, Larsen PN, Tetens V, Büchler MW (2011) Hemostatic efficacy of TachoSil in liver resection compared with argon beam coagulator treatment: an open, randomized, prospective, multicenter, parallel-group trial. Surgery 149(1):48–55PubMedCrossRefPubMedCentralGoogle Scholar
  65. 65.
    de Boer MT, Klaase JM, Verhoef C, van Dam RM, van Gulik TM, Molenaar IQ, Bosscha K, Dejong CH, van der Jagt E, Porte RJ, FRESCO Trial Group (2012) Fibrin sealant for prevention of resection surface-related complications after liver resection: a randomized controlled trial. Ann Surg 256(2):229–234PubMedCrossRefPubMedCentralGoogle Scholar
  66. 66.
    Karanicolas PJ, Lin Y, Tarshis J, Law CH, Coburn NG, Hallet J et al (2016) Major liver resection, systemic fibrinolytic activity, and the impact of tranexamic acid. HPB (Oxford) 18(12):991–999CrossRefGoogle Scholar
  67. 67.
    Schneeweiss S, Seeger JD, Landon J, Walker AM (2008) Aprotinin during coronary-artery bypass grafting and risk of death. N Engl J Med 358(8):771–783PubMedCrossRefPubMedCentralGoogle Scholar
  68. 68.
    Ker K, Roberts I (2015) Exploring redundant research into the effect of tranexamic acid on surgical bleeding: further analysis of a systematic review of randomised controlled trials. BMJ Open 5(8):e009460PubMedPubMedCentralCrossRefGoogle Scholar
  69. 69.
    Wu CC, Ho WM, Cheng SB, Yeh DC, Wen MC, Liu TJ, P’eng FK (2006) Perioperative parenteral tranexamic acid in liver tumor resection: a prospective randomized trial toward a "blood transfusion"-free hepatectomy. Ann Surg 243(2):173–180PubMedPubMedCentralCrossRefGoogle Scholar
  70. 70.
    Shao YF, Yang JM, Chau GY, Sirivatanauksorn Y, Zhong SX, Erhardtsen E, Nivatvongs S, Lee PH (2006) Safety and hemostatic effect of recombinant activated factor VII in cirrhotic patients undergoing partial hepatectomy: a multicenter, randomized, double-blind, placebo-controlled trial. Am J Surg 191(2):245–249PubMedCrossRefPubMedCentralGoogle Scholar
  71. 71.
    Lodge JP, Jonas S, Oussoultzoglou E, Malagó M, Jayr C, Cherqui D et al (2005) Recombinant coagulation factor VIIa in major liver resection: a randomized, placebo-controlled, double-blind clinical trial. Anesthesiology 102(2):269–275PubMedCrossRefPubMedCentralGoogle Scholar
  72. 72.
    Wang WD, Liang LJ, Huang XQ, Yin XY (2006) Low central venous pressure reduces blood loss in hepatectomy. World J Gastroenterol 12(6):935–939PubMedPubMedCentralCrossRefGoogle Scholar
  73. 73.
    Gurusamy KS, Li J, Vaughan J, Sharma D, Davidson BR (2012) Cardiopulmonary interventions to decrease blood loss and blood transfusion requirements for liver resection. Cochrane Database Syst Rev 5:CD007338Google Scholar
  74. 74.
    Melendez JA, Arslan V, Fischer ME, Wuest D, Jarnagin WR, Fong Y, Blumgart LH (1998) Perioperative outcomes of major hepatic resections under low central venous pressure anesthesia: blood loss, blood transfusion, and the risk of postoperative renal dysfunction. J Am Coll Surg 187(6):620–625PubMedCrossRefPubMedCentralGoogle Scholar
  75. 75.
    Hughes MJ, Ventham NT, Harrison EM, Wigmore SJ (2015) Central venous pressure and liver resection: a systematic review and meta-analysis. HPB (Oxford) 17(10):863–871CrossRefGoogle Scholar
  76. 76.
    Hasegawa K, Takayama T, Orii R, Sano K, Sugawara Y, Imamura H, Kubota K, Makuuchi M (2002) Effect of hypoventilation on bleeding during hepatic resection: a randomized controlled trial. Arch Surg 137(3):311–315PubMedCrossRefPubMedCentralGoogle Scholar
  77. 77.
    Wax DB, Zerillo J, Tabrizian P, Schwartz M, Hill B, Lin HM, DeMaria S Jr (2016) A retrospective analysis of liver resection performed without central venous pressure monitoring. Eur J Surg Oncol 42(10):1608–1613PubMedCrossRefPubMedCentralGoogle Scholar
  78. 78.
    Messmer K, Kreimeier U, Intaglietta M (1986) Present state of intentional hemodilution. Eur Surg Res 18(3–4):254–263PubMedCrossRefPubMedCentralGoogle Scholar
  79. 79.
    Jarnagin WR, Gonen M, Maithel SK, Fong Y, D'Angelica MI, Dematteo RP, Grant F, Wuest D, Kundu K, Blumgart LH, Fischer M (2008) A prospective randomized trial of acute normovolemic hemodilution compared to standard intraoperative management in patients undergoing major hepatic resection. Ann Surg 248(3):360–369PubMedPubMedCentralGoogle Scholar
  80. 80.
    Rekman J, Wherrett C, Bennett S, Gostimir M, Saeed S, Lemon K, Mimeault R, Balaa FK, Martel G (2017) Safety and feasibility of phlebotomy with controlled hypovolemia to minimize blood loss in liver resections. Surgery 161(3):650–657PubMedCrossRefPubMedCentralGoogle Scholar
  81. 81.
    Carless PA, Henry DA, Moxey AJ, O'Connell D, Brown T, Fergusson DA (2010) Cell salvage for minimising perioperative allogeneic blood transfusion. Cochrane Database Syst Rev 4:CD001888Google Scholar
  82. 82.
    Waters JH, Yazer M, Chen YF, Kloke J (2012) Blood salvage and cancer surgery: a meta-analysis of available studies. Transfusion 52(10):2167–2173PubMedCrossRefPubMedCentralGoogle Scholar
  83. 83.
    Lemke M, Eeson G, Lin Y, Tarshis J, Hallet J, Coburn N, Law C, Karanicolas PJ (2016) A decision model and cost analysis of intra-operative cell salvage during hepatic resection. HPB (Oxford) 18(5):428–435CrossRefGoogle Scholar
  84. 84.
    Harper CM, McNicholas T, Gowrie-Mohan S (2003) Maintaining perioperative normothermia. BMJ 326(7392):721–722PubMedPubMedCentralCrossRefGoogle Scholar
  85. 85.
    Mallett SV, Sugavanam A, Krzanicki DA, Patel S, Broomhead RH, Davidson BR, Riddell A, Gatt A, Chowdary P (2016) Alterations in coagulation following major liver resection. Anaesthesia 71(6):657–668PubMedCrossRefPubMedCentralGoogle Scholar
  86. 86.
    Lee J, Kwon CH, Kim JM, Shin M, Joh JW (2012) Effect of early enteral nutrition after hepatectomy in hepatocellular carcinoma patients. Korean J Hepatobiliary Pancreat Surg 16(4):129–133PubMedPubMedCentralCrossRefGoogle Scholar
  87. 87.
    Barton JS, Riha GM, Differding JA, Underwood SJ, Curren JL, Sheppard BC, Pommier RF, Orloff SL, Schreiber MA, Billingsley KG (2013) Coagulopathy after a liver resection: is it over diagnosed and over treated? HPB (Oxford) 15(11):865–871CrossRefGoogle Scholar
  88. 88.
    Holst LB, Petersen MW, Haase N, Perner A, Wetterslev J (2015) Restrictive versus liberal transfusion strategy for red blood cell transfusion: systematic review of randomised trials with meta-analysis and trial sequential analysis. BMJ 350:h1354PubMedPubMedCentralCrossRefGoogle Scholar
  89. 89.
    Hébert PC (1998) Transfusion requirements in critical care (TRICC): a multicentre, randomized, controlled clinical study. Transfusion Requirements in Critical Care Investigators and the Canadian Critical care Trials Group. Br J Anaesth 81(Suppl 1):25–33PubMedPubMedCentralGoogle Scholar
  90. 90.
    Carson JL, Guyatt G, Heddle NM, Grossman BJ, Cohn CS, Fung MK, Gernsheimer T, Holcomb JB, Kaplan LJ, Katz LM, Peterson N, Ramsey G, Rao SV, Roback JD, Shander A, Tobian AAR (2016) Clinical practice guidelines from the AABB: red blood cell transfusion thresholds and storage. JAMA 316(19):2025–2035PubMedCrossRefPubMedCentralGoogle Scholar
  91. 91.
    Kotzé A, Harris A, Baker C, Iqbal T, Lavies N, Richards T, Ryan K, Taylor C, Thomas D (2015) British committee for standards in haematology guidelines on the identification and management of pre-operative anaemia. Br J Haematol 171(3):322–331PubMedCrossRefPubMedCentralGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of SurgeryUniversity of TorontoTorontoCanada
  2. 2.Division of General SurgerySunnybrook Health Sciences CentreTorontoCanada
  3. 3.Department of SurgerySunnybrook Health Sciences CentreTorontoCanada

Personalised recommendations