Transfusion Tsunami: A 132-Liter Resuscitation Using Crystalloids, Colloids, Blood, and Coagulation Factors During Liver Transplantation

TL;DR

A liver transplant patient required 132 liters of fluids and blood products in 24 hours, highlighting the challenges of ultra-massive transfusion during such surgeries.

Contribution

This case presents an exceptionally high-volume transfusion during liver transplantation, offering insights into managing severe intraoperative bleeding.

Findings

The patient received 132 liters of fluids and blood products in 24 hours during liver transplant.

Despite complications, the patient fully recovered with normal graft function one year post-transplant.

The case underscores the need for a multifaceted approach to ultra-massive transfusion in advanced liver disease.

Abstract

Despite advancements in surgical technique and anesthetic management, liver transplantation continues to pose a significant risk of intraoperative bleeding requiring substantial transfusion support. We describe an adult patient who underwent an orthotopic liver transplant and received a total of 132 liters of fluid within a 24-hour period, comprising 50 packed red blood cell units, 20 pooled platelet units, 24 fresh frozen plasma units, and 100 cryoprecipitate units. This case emphasizes the multifaceted approach to ultra-massive transfusion in patients with advanced liver disease who undergo liver transplantation. The immediate postoperative course was complicated by primary graft failure requiring re-transplantation. Although the postoperative course was complicated by sepsis, respiratory failure, bile leak, portal vein thrombosis, and renal impairment, with ongoing medical management and rehabilitation, the patient made a full recovery. One year post-transplant, graft function remains normal, and the patient has returned to his previous activities of daily living.

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