Changing trends in transfusion practice in liver transplantation

Ozier, Yves; Tsou, Mei-Yung

doi:10.1097/mot.0b013e3282faa0dd

Cited by 38 publications

(21 citation statements)

References 62 publications

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“…The variable that has most frequently been related to transfusion is preoperative hemoglobin [2,15,16,18]. In our study, prior lower levels of hemoglobin significantly increased the transfusion requirements of all blood products (RBCs, PCs, FFPs).…”

Section: Discussionsupporting

confidence: 50%

“…Traditionally, it has been associated with major blood loss and consequently high blood transfusion requirements [1]. During the last decade, some improvements in surgical techniques, anesthetic management, and organ conservation as well as better knowledge of hemostatic disorders during the process have significantly contributed to the reduction of the transfusion needs [2]. In spite of this, a great variability in transfusion rates between centers have been published, ranging between 0 and more than 100 red blood cell (RBC) units transfused during the procedure.…”

Section: Introductionmentioning

confidence: 99%

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Transfusion Management and Immunohematologic Complications in Liver Transplantation: Experience of a Single Institution

Solves

Carpio

Moscardó

et al. 2014

Transfus Med Hemother

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Objective: Liver transplantation (LT) has traditionally been associated with major blood loss and consequently high blood transfusion requirements. Our objective was to analyze transfusion management and incidence of immunohematologic complications in patients undergoing LT at our institution. Methods: A retrospective analysis of immunohematologic events and transfusion outcomes was carried out at La Fe University Hospital in Valencia. Data from 654 patients were reviewed: 654 underwent only one LT while 36 underwent second LT. Results: Patients received a median of 3 red blood cell (RBC) concentrates, 2 platelets concentrates (PCs) and 2 fresh frozen plasma units (FFPs). Variables significantly influencing RBC transfusions were: the MELD score, hemoglobin levels, and the platelet counts before LT. 27 patients (4.1%) had a positive antibody screening before transplant. Immunohematologic events occurred in 8% of the patients, mostly in the first month after LT, and involved hemolysis in 13 cases. Mortality was significantly higher in patients developing immunohematologic disorders (42.8 vs. 18.3%; p < 0.001). In the multivariable analysis, only ABO minor incompatibility between donor and recipient significantly increased the appearance of immunohematologic incidences (OR 4.92, 95% CI 2.31-10.50; p < 0.001). Conclusion: Transfusion management of patients that underwent LT can be complicated by immunohematologic problems. Blood banks should implement the DAT test in each transfusion to detect them.

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Section: Discussionsupporting

confidence: 50%

Section: Introductionmentioning

confidence: 99%

Transfusion Management and Immunohematologic Complications in Liver Transplantation: Experience of a Single Institution

Solves

Carpio

Moscardó

et al. 2014

Transfus Med Hemother

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“…Acute volume loading tends to pool in the splanchnic circulation leading to bleeding and hepatic congestion with minimal improvement in cardiac preload or output [63] . Dilution of clotting factors and interruption of clot formation (particularly with colloid administration) can lead to significant clot disturbance [64,65] in this susceptible patient group [44] .…”

Section: Managementmentioning

confidence: 99%

Reducing transfusion requirements in liver transplantation

Donohue

Mallett

2015

WJT

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Liver transplantation (LT) was historically associated with massive blood loss and transfusion. Over the past two decades transfusion requirements have reduced dramatically and increasingly transfusionfree transplantation is a reality. Both bleeding and transfusion are associated with adverse outcomes in LT. Minimising bleeding and reducing unnecessary transfusions are therefore key goals in the perioperative period. As the understanding of the causes of bleeding has evolved so too have techniques to minimize or reduce the impact of blood loss. Surgical "piggyback" techniques, anaesthetic low central venous pressure and haemodilution strategies and the use of autologous cell salvage, point of care monitoring and targeted correction of coagulopathy, particularly through use of factor concentrates, have all contributed to declining reliance on allogenic blood products. Pre-emptive management of preoperative anaemia and adoption of more restrictive transfusion thresholds is increasingly common as patient blood management (PBM) gains momentum. Despite progress, increasing use of marginal grafts and transplantation of sicker recipients will continue to present new challenges in bleeding and transfusion management. Variation in practice across different centres and within the literature demonstrates the current lack of clear transfusion guidance. In this article we summarise the causes and predictors of bleeding and present the evidence for a variety of PBM strategies in LT. Core tip: Liver transplantation (LT) was historically associated with massive blood loss. Many factors have contributed to the decline in bleeding and transfusion in the past two decades including refinement of surgical techniques, anaesthetic management and the use of point of care guided goal-directed haemostatic therapies. Increasing awareness of the adverse associations of allogenic transfusion has driven the quest for transfusion-free transplantation. Increasing use of marginal grafts and transplantation of sicker recipients will continue to challenge perioperative care and transfusion practice. Inter-institutional variability suggests a current lack of clear guidance and limited application of the principles of patient blood management to LT.

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“…Unfortunately, accumulating evidence indicated that transfusion of red blood cell (RBC) increased the adverse event rate and led to poor prognosis in post-transplantation patients (Xia et al, 2006;Scornik et al, 2009;Massicotte et al, 2012;Rana et al, 2013). Although the significant improvement of surgical techniques and anesthetic practice had markedly decreased the transfusion frequency (Ozier et al, 2008) and even some successful cases of transfusionfree organ transplantation were reported (Massicotte , 2012), there was still a considerable variability among medical institutions. The phenomenon could be partially explained by the disparity of surgical practice, anesthetic management, and blood transfusion policy in different centers (Pilar et al, 2015); but the potential pathophysiology remained to be elucidated.…”

Section: Introductionmentioning

confidence: 99%

Clinical Practice of Blood Transfusion in Orthotopic Organ Transplantation: A Single Institution Experience

Tsai

Hsieh²,

Chang³

et al. 2015

Asian Pacific Journal of Cancer Prevention

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Background: Orthotopic organ transplantation, a treatment option for irreversible organ dysfunction according to organ failure, severe damaged organ or malignancy in situ, was usually accompanied with massive blood loss thus transfusion was required. We aimed to evaluate the adverse impact of blood transfusion on solid organ transplantation. Materials and Methods: From January, 2009 to December, 2014, patients who received orthotopic organ transplantation at Far Eastern Memorial Hospital medical center were enrolled. Clinical data regarding anemia status and red blood cell (RBC) transfusion before, during and after operation, as well as patient outcomes were collected for further univariate analysis. Results: A total of 105 patients who underwent orthotopic transplantation, including liver, kidney and small intestine were registered. The mean hemoglobin (Hb) level upon admission and before operation were 11.6±1.8 g/dL and 11.7±1.7 g/dL, respectively; and the nadir Hb level post operation and the final Hb level before discharge were 8.3±1.6 g/dL and 10.2±1.6 g/dL, respectively. The median units (interquartile range) of RBC transfusion in pre-operative, peri-operative and post-operative periods were 0 (0-0), 2 (0-12), and 2 (0-6) units, respectively. Furthermore, the median (interquartile range) length of hospital stay (LHS) from admission to discharge and from operation to discharge were 28 (17-44) and 24 (16-37) days, respectively. Both peri-operative and post-operative RBC transfusion were associated with longer LHS from admission to discharge and from operation to discharge. Furthermore, it increased the risk of post-operative septicemia. While peri-operative RBC transfusion elevated the risk of acute graft rejection in patients who received orthotopic transplantation. Conclusions: Worse outcome could be anticipated in those who had received massive RBC transfusion in transplantation operation. Hence, peri-operative RBC transfusion should be avoided as much as possible.

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Changing trends in transfusion practice in liver transplantation

Abstract: Recent studies call for continuing every reasonable effort to minimize the use of blood components and can guide us in new approaches to this vital problem.

Cited by 38 publications

References 62 publications

Transfusion Management and Immunohematologic Complications in Liver Transplantation: Experience of a Single Institution

Transfusion Management and Immunohematologic Complications in Liver Transplantation: Experience of a Single Institution

Reducing transfusion requirements in liver transplantation

Clinical Practice of Blood Transfusion in Orthotopic Organ Transplantation: A Single Institution Experience

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