Reduced transfusion requirements during major hepatic resection with use of intraoperative isovolemic hemodilution

Background: Allogeneic blood transfusion during liver resection for malignancies has been associated with an increased incidence of tumor recurrence and decreased survival in some series. Isovolemic hemodilution (IH) has been utilized in cardiac, orthopedic, and major general surgery procedures to reduce the use of banked blood products. We therefore sought to determine the safety and efficacy of IH during major hepatic resection in an adult population. Methods: Thirteen consecutive patients undergoing major hepatic resection with IH were compared with 13 age- and disease-matched controls. The diseases included metastatic colorectal adenocarcinoma (8 versus 9), hepatoma (2 in each group) and other (3 versus 2); and the procedures included total (right or left) hepatic lobectomy (8 versus 11), partial lobectomy (3 versus 1) and trisegmentectomy (2 versus 1). Results: There was no significant difference in operating time, estimated blood loss, fresh frozen plasma, platelets, amount of crystalloid or colloid infused between the two groups. There was no perioperative morbidity related to IH. The use of IH resulted in a 60% reduction in mean packed red blood cells transfusion during major hepatic resection. Only 38% of patients undergoing IH required packed red cells transfusion, whereas 77% of historical control patients required allogenic transfusion. Conclusion: The use of IH reduces the need for homologous transfusion during major hepatic resection. IH is a safe technique during hepatic resection and is not associated with perioperative morbidity.