# 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.

## Key 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.