Liver Transplantation Hemorrhage: Taking Bleeding to Another Level
Liver transplantation creates the perfect storm for the development of massive, uncontrolled hemorrhage. The pathophysiology of liver disease, including portal hypertension, leads to high-pressure collaterals that course through all of the abdominal tissue planes. In addition, liver disease also results in severe coagulopathy from the lack of clotting synthesis and platelet sequestration in the spleen. The location of liver makes things worse, as it is located in the “surgical soul” of the abdomen where all of the major blood vessels convene. Over the last several decades, improvements in the technical skill set needed for liver transplantation, as well as anesthesiology techniques and understanding of coagulation, have all led to liver transplantation being a successful operation and the only cure for end-stage liver disease and hepatocellular carcinoma in patients with cirrhosis. The chapter will discuss the treatment of hemorrhage in patients undergoing liver transplantation.