Effects of Continuous Octreotide Infusion on Intraoperative Transfusion Requirements during Orthotopic Liver Transplantation

Orthotopic liver transplantation (OLT) is often associated with major hemorrhage and a large red blood cell (RBC) transfusion requirement. Massive transfusion during OLT has been associated with decreased patient and graft survival. As a result, the anesthesiologist may use various techniques to decrease intraoperative blood loss and transfusion requirements, including maintenance of a low central venous pressure, antifibrinolytic drugs, cell salvage, and vasopressors. Due to its properties of splanchnic vasoconstriction and resultant decrease in portal venous blood flow, octreotide may decrease blood loss during the preanhepatic phase of OLT. We performed a retrospective review of 50 consecutive liver transplantations; a continuous octreotide infusion was used during the preanhepatic phase in 30 of these cases. We hypothesized that intraoperative transfusion requirements would be reduced in those patients treated with octreotide. Statistical analysis found that the number of RBCs transfused decreased from 20.4 U to 18.1 U when octreotide was used, although this result was not statistically significant (P =.5). Additional analysis found a significant positive correlation between the number of RBCs transfused and total operating room (OR) time, preoperative international normalized ratio (INR), and model for end-stage liver disease (MELD) and a negative correlation between the number of RBCs transfused and preoperative platelets and hemoglobin. Although our small study did not show a statistical difference in the number of units transfused, there was an absolute difference. A prospective, randomized trial would be useful in elucidating the true effect of octreotide on RBC transfusion requirements during OLT.