**11. References**


guideline of 50 X 109 L-1) secures coagulation competence and additional administration of platelets is routinely performed before the reperfusion of the donor liver associated with significant use of platelets (Johansson *et al.*, 2010). Thus, the coagulation competence of the patient's blood is accentuated by the administration of FFP and saline-adenine-glucosemannitol (SAGM) erythrocyte suspension to a haemoglobin concentration of 6 mM (haematocrit 30%), making sure that plasma calcium does not decrease and calcuimcloride is

Yet it has to be accepted that some patients have intraoperative increased consumption of fibrinogen and if a diffuse bleeding in combination with a reduced α and MA manifest, we suggest monitoring functional fibrinogen to decide whether the reduction in MA relates to platelet or to fibrinogen function. Attention has also been directed to the endothelial barrier function in response to haemorrhagic shock and the role of glycocalyx appears important to

Until recently, infusion of aprotinin was an option for OLT and aprotinin reduces haemorrhage by hindering fibrinolyses and thereby stabilizes the formed blood clots. Aprotinin has, however, been withdrawn from the marked (Dietrich, 2009) and tranexamic acid is the (cheaper) alternative to be administrated before surgery and again before

Further refinement of treatment includes control of plasma concentration of magnesium (Skak et al., 1996) and corrected if low (reference value 0.8 mM) and maintenance of the blood glucose or, conversely, administration of insulin in case the blood glucose level increases beyond 10 mM. Surprisingly, the blood glucose level does not decrease during the anhepatic phase of OLT, presumably because the kidneys supplement glucose production (Lauritsen *et al.*, 2002). Also it should be considered that during massive administration of blood products, HR might be affected by the potassium concentration of Sag-M blood of approximately 50 mM. It is advised that massive administration of blood is paralleled by

During OLT it is possible to maintain coagulation competence by timely administration of fresh frozen plasma and platelets together with SAGM-blood while body temperature and plasma pH and calcium are controlled. Notably platelets are supplemented to a reference value of 100 X 109 L-1 rather than 50 X 109 L-1 seems to increase survival. Even massive bleeding can be coped with if CBV and thereby ScO2, at all times is kept within narrow limits. To maintain a stable central blood volume requires that treatment of patients with

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**10. Conclusion** 

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