Jarnagin 2008.

Methods	Randomised clinical trial.
Participants	Country: USA. Number randomised: 135. Post‐randomisation drop‐outs: 5 (3.7%). Mean age: 53.5 years. Females: 61 (46.9%). Major liver resections: 111 (85.4%). Cirrhotic livers: not stated. Inclusion criteria: Adult patients older than 18 years of age Pre‐operative haemoglobin at least 11 g/dL for men and 10 g/dL for women within 14 days of registration. Exclusion criteria: Active coronary artery disease (exceptions for cardiac stress study showing no reversible ischaemia) History of cerebrovascular disease History of congestive heart failure Uncontrolled hypertension Restrictive or obstructive pulmonary disease (COPD) Renal dysfunction (creatinine  > 1.8 mg/dL) Abnormal coagulation parameters (INR > 1.5 not on warfarin and/or platelet count < 100,000) Presence of active infection Evidence of hepatic metabolic disorder (bilirubin > 2 mg/dL or ALT > 75 U/L) Pre‐operative autologous blood donation.
Interventions	Participants were randomly assigned to two groups. Group 1: haemodilution (n = 63). Group 2: control (n = 67). Further details of intervention: haemodilution by withdrawing blood and replacing it with colloids to a target haemoglobin of 8 gm/dl. Other details: Vascular occlusion: intermittent PTC. Method of parenchymal transection:not stated. Management of raw surface: not stated. Other co‐interventions to decrease blood loss: low CVP in both groups.
Outcomes	The outcomes reported were mortality, transfusion requirements, peri‐operative morbidity, operating time, and hospital stay.
Notes	There were 3 drop‐outs in ANH group and 2 in standard.  The reason for drop‐outs were resection not performed in 2, resection smaller than required by the study in 2 and inability to accurately determine blood loss in 1 (author replies). Authors replied to questions related to methodological quality in November 2008.
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Low risk	Quote: "The random sequence was computer generated" (author replies).
Allocation concealment (selection bias)	Unclear risk	Quote: "Allocation was concealed by sealed envelopes" (author replies). Comment: It is not clear whether the authors used opaque envelopes.
Blinding of participants and personnel (performance bias) All outcomes	Unclear risk	Comment: This information was not available.
Blinding of outcome assessment (detection bias) All outcomes	Unclear risk	Comment: This information was not available.
Incomplete outcome data (attrition bias) All outcomes	High risk	Comment: There were 5 post‐randomisation drop‐outs.
Selective reporting (reporting bias)	High risk	Comment: Important outcomes such as liver failure were not reported.
Free of vested interest bias?	Low risk	Quote: "The authors thank ... Robert Wittes, MD, Physician‐in‐Chief, Memorial Hospital, for providing financial support."