الفهرس 
IntroductionOnly 14 pages are availabe for public view
 |  | from | 146 |  |  |
| | | from | 146 | | |
Abstract
Liver transplantation has become the first choice approach for the treatment of patients with end-stage liver diseases. However, despite great improvements in graft preservation, surgical skills, anesthetic techniques and perioperative management, liver transplantation is still associated with severe bleeding and considerable transfusion requirements, which in turn greatly contribute to the perioperative morbidity and mortality.
Severe bleeding in LTx occurs for several reasons, among which hemostatic abnormalities remain a major cause because hepatic dysfunction brings complex changes in the natural balance of the normal state of haemostasis: the imbalance between coagulation and its inhibition, as well as fibrin polymerization and fibrinolysis resulting in all forms of coagulopathy. Treating this global haemostatic imbalance is the sine qua non of managing patients for LTx. Other complicating conditions, such as renal insufficiency and surgical bleeding, make a transfusion-free LTx a major challenge
Evolution of surgical and perioperative care, as well as better understanding of risk factors for excessive blood loss in patients undergoing liver transplantation, have resulted in a steady decrease in intraoperative blood loss and transfusion requirements. Some centers report a complete avoidance of blood product transfusions in up to 40% of liver transplant recipients.
Several blood conserving strategies are implicated in liver transplantation including the use of autologous blood in the form of increasing preoperative RBCs mass, preoperative autologous blood donation, acute normovolemic hemodilution, and blood salvage. Aprotinin, counteracting fibrinolysis with antifibrinolytic agent, recombinant factor VIIa and topical agents are pharmacological methods used to decrease blood loss. Anesthetic techniques to conserve blood include controlled hypotension and normothermia.
While the need for blood is widespread, there is a major imbalance between demand and supply of donors. This evidence, along with other limitations of traditional blood transfusion has prompted a mounting research to develop suitable surrogates for human donated blood.
Ongoing efforts are placed to produce “artificial blood” components including RBCs and platelets. Moreover, several plasma proteins artificially produced by recombinant DNA technology such as activated factor VII, factor VIII, factor IX, activated protein C, thrombin, antithrombin, soluble thrombomodulin, tissue factor pathway inhibitor, and tissue plasminogen activator