Transfusion based on clinical coagulation monitoring does reduce hemorrhage during liver transplantation

intraoperative hypothermia, goal-directed transfusion, and routine application of aprotinin the median blood loss in primary transplants in this series was 6 U of packed red cells (range, 0-150 U) and 8 U of fresh frozen plasma (range, 0-150 U).Despite these comparatively low transfusion needs, we still see a negative correlation between blood loss and posttransplantation survival: patients who needed more than 9 U of red blood cells intraoperatively had an actual 1-year survival of 86.1% compared with those who needed up to 9 U of red blood cells (75%) intraoperatively and had a 1-year actual survival of 92% (P ϭ .034).Finally, a word of caution: despite the optimism generated by new opportunities with pharmacological intervention, surgical skill and experience are probably still the strongest predictors of blood loss in liver transplantation.