In Reply:—
I take this opportunity to thank Drs. Lentschener and Ozier for their comments and showing keen interest in our recent article. 1It is true that the number of liver resections without transfusion has increased substantially in recent years. However, as reported by Gozzetti et al. 2and Rees et al. , 3despite the improvement in surgical and anesthetic technique, 41% and 38% of liver resections (minor and major) required transfusion, respectively. In addition, only 19.6% of major hepatectomies were performed without intraoperative blood transfusion. 2Although in the present study we included ASA 1 or 2 patients, the study included only patients scheduled to major hepatic resections. Moreover, a third of the patients had previous surgery, and on four occasions, the vena cava was involved. Therefore, I believe that the 36% transfusion rate found in the present study is not unacceptable. I agree with Lentschener and Ozier that acute normovolemic hemodilution is not expected to lower the need for blood transfusion in all patients undergoing liver resection. However, as suggested in the present study, it may benefit patients undergoing major hepatic resections. It seems that future work in this area should focus on Child B patients, as suggested by Lentschener and Ozier.