Transfusion Tsunami: A 132-Liter Resuscitation Using Crystalloids, Colloids, Blood, and Coagulation Factors During Liver Transplantation.

Despite advancements in surgical technique and anesthetic management, liver transplantation continues to pose a significant risk of intraoperative bleeding requiring substantial transfusion support. We describe an adult patient who underwent an orthotopic liver transplant and received a total of 132 liters of fluid within a 24-hour period, comprising 50 packed red blood cell units, 20 pooled platelet units, 24 fresh frozen plasma units, and 100 cryoprecipitate units. This case emphasizes the multifaceted approach to ultra-massive transfusion in patients with advanced liver disease who undergo liver transplantation. The immediate postoperative course was complicated by primary graft failure requiring re-transplantation. Although the postoperative course was complicated by sepsis, respiratory failure, bile leak, portal vein thrombosis, and renal impairment, with ongoing medical management and rehabilitation, the patient made a full recovery. One year post-transplant, graft function remains normal, and the patient has returned to his previous activities of daily living.