简介：Recentfindingsinthepathophysiologyandmonitoringofhemostasisinpatientswithendstageliverdiseasehavemajorimpactoncoagulationmanagementduringlivertransplantation.Thereisincreasingevidence,thatthechangesinbothcoagulationfactorsandplateletcountregularlyobservedinpatientswithlivercirrhosiscannotbeinterpretedasareliableindicatorofdiffusebleedingrisk.Instead,adifferentiatedviewonhemostasishasledtotheconceptofarebalancedcoagulationsystemWhileitisimportanttorecognizethatprocoagulantfactorsarereducedinlivercirrhosis,itisalsoevidentthatsynthesisofanticoagulantfactorsandfibrinolyticproteinsproducedintheliverisalsodiminished.Similarly,thedecreasedplateletcountmaybecounterbalancedbyincreasedplateletaggregabilitycausedbyhighlyactivevonWillebrandmultimeres.Thecoagulationsystemisthereforstatedtoberebalanced.Whileundernormal＂unstressed＂conditionsdiffusebleedingisrarelyobserved,howeverbothdiffusebleedingorthrombusformationmayoccurwhencompensationmechanismsareexhausted.Whilemostpatientspresentingforlivertransplantationhaveseverecirrhosis,liverfunctionandthusproductionofpro-andanticoagulantfactorscanbepreservedespeciallyincholestaticliverdisease.Duringlivertransplantation,profoundchangesinthehemostasissystemcanoccur.Surgicalbleedingcanleadtodiffusebleedingascoagulationfactorsandplateletsarealreadyreduced.Ischemiaandtissuetraumacanleadtoalterationsofhemostasiscomparabletotraumainducedcoagulopathy.Afurthercommondisturbanceoftenstartingwiththereperfusionofthetransplantedorganishyperfibrinolysiswhichcaneventuallyprecipitatecompleteconsumptionoffibrinogenandanendogenousheparinizationbyglycocalyxshedding.Moreover,thromboticeventsinlivertransplantationsarenotuncommonandcontributetoincreasedmortality.Besidesconventionallaboratorymethods,bed-sidemonitoringofhemostasis（e.g.,thrombelastography,thrombe