Monitoring of Haemostasis during Liver Transplantation

When end stage liver disease occurs, liver transplantation is the only effective treatment available. In the past, liver transplantation was frequently accompanied by considerable bleeding complications and massive transfusion requirements, while only in recent years advances in operative management and a better understanding of the pathophysiology of coagulation have determined a better outcome for this major surgery. In addition, accumulating evidence shows that the overall haemostatic function in patients with cirrhosis facing liver transplantation may not be shifted towards a bleeding diathesis as traditionally believed, but that both bleeding episodes and thrombotic events may take place as major peri- and post-operative complications in patients undergoing liver surgery. The aim of this review paper is to offer an overview of recent developments that have gradually improved our understanding about the changes that may occur in the haemostatic system of patients undergoing liver transplantation, taking into account the best way to monitor them.