Is There a Role for Desmopressin in Liver Transplantation? A Case Report

• Perioperative bleeding is a serious complication in liver transplantation, especially in the setting of living donation.
• During liver transplantation: coagulation “undercorrection” may lead to persisting bleeding and massive transfusions, but coagulation “overcorrection” increases the risk of hepatic artery thrombosis.
• Routine laboratory coagulation tests (platelet count, PT, and aPTT) cannot predict the risk of bleeding in patients with complex hemostatic alterations (e.g. cirrhotics).
• We proposed that DDAVP may be considered for persisting bleeding after correcting common coagulation abnormalities in liver transplantation, particularly when complex vascular anastomosis may preclude the use of more aggressive interventions.

Living donor liver transplantation reduces time and mortality on the waiting list. Bleeding is a serious complication; however, “overcorrection” of coagulopathy may lead to hepatic artery thrombosis. We report a case where desmopressin (DDAVP) was used in the management of persistent postreperfusion bleeding (44 red blood cell units transfused). After 1 dose of DDAVP, bleeding improved significantly and the recipient had an unremarkable recovery. DDAVP should be considered for persisting bleeding after correcting common coagulation abnormalities where complexity of the anastomosis may preclude the use of more aggressive procoagulant drugs in liver transplantation.