Impact of Blood Loss and Intraoperative Blood Transfusion During Liver Transplantation on the Incidence of Early Biliary Complications and Mortality

Jóźwik, Agnieszka; Karpeta, Edyta; Nita, Magdalena; Łągiewska, B; Pacholczyk, Marek

doi:10.1016/j.transproceed.2020.03.052

Cited by 7 publications

(16 citation statements)

References 9 publications

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“…Similarities of matched groups in all aspects (preoperative variables and patient demographics) could well balance the confounding factors of retrospective cohort study, for maintaining baselines consistency in two groups and reducing selection bias. Unlike in previous studies [7], we excluded patients with fulminant hepatic failure, for these patients often already received massive blood transfusion before LT, and were often accompanied with severe comorbidities, such as gastrointestinal bleeding, severe infection, hepatorenal syndromes and requiring preoperative RRT, also with high MELD scores [31][32][33][34]. We thought that severe pre-existing comorbidities might easily become uncontrollable confounding factor and interfere with the research results.…”

Section: Discussionmentioning

confidence: 99%

“…Consequently, MT is considered to be associated with early mortality and even worsened outcomes 6 . Recent studies also have shown that MT may affect the recovery of liver function after transplantation and reduce the postoperative survival 7 , 8 . However, to our knowledge, few studies have discussed the impacts of MT in perioperative periods of LT on long-term outcomes.…”

Section: Introductionmentioning

confidence: 99%

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Impact of Perioperative Massive Transfusion on Long Term Outcomes of Liver Transplantation: a Retrospective Cohort Study

Tan¹,

Xiao-zhen²,

Yue³

et al. 2021

Int. J. Med. Sci.

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Background: Liver transplantation (LT) is associated with a significant risk of intraoperative hemorrhage and massive blood transfusion. However, there are few relevant reports addressing the long-term impacts of massive transfusion (MT) on liver transplantation recipients. Aim: To assess the effects of MT on the short and long-term outcomes of adult liver transplantation recipients. Methods: We included adult patients who underwent liver transplantation at West China Hospital from January 2011 to February 2015. MT was defined as red blood cell (RBC) transfusion of ≥10 units within 48 hours since the application of LT. Preoperative, intraoperative and postoperative information were collected for data analyzing. We used one-to-one propensity-matching to create pairs. Kaplan-Meier survival analysis was used to compare long-term outcomes of LT recipients between the MT and non-MT groups. Univariate and multivariate logistic regression analyses were performed to evaluate the risk factors associated with MT in LT. Results: Finally, a total of 227 patients were included in our study. After propensity score matching, 59 patients were categorized into the MT and 59 patients in non-MT groups. Compared with the non-MT group, the MT group had a higher 30-day mortality (15.3% vs 0, p=0.006), and a higher incidence of postoperative complications, including postoperative pulmonary infection, abdominal hemorrhage, pleural effusion and severe acute kidney injury. Furthermore, MT group had prolonged postoperative ventilation support (42 vs 25 h, p=0.007) and prolonged durations of ICU (12.9 vs 9.5 d, p<0.001) stay. Multivariate COX regression indicated that massive transfusion (OR: 2.393, 95% CI: 1.164-4.923, p=0.018) and acute rejection (OR: 7.295, 95% CI: 2.108-25.246, p=0.02) were significant risk factors affecting long-term survivals of LT patients. The 1-year and 3-year survival rates patients in MT group were 82.5% and 67.3%, respectively, while those of non-MT group were 93.9% and 90.5%, respectively. The MT group exhibited a lower long-term survival rate than the non-MT group (HR: 2.393, 95% CI: 1.164-4.923, p<0.001). Finally, the multivariate logistic regression revealed that preoperative hemoglobin <118 g/L (OR: 5.062, 95% CI: 2.292-11.181, p<0.001) and intraoperative blood loss ≥1100 ml (OR: 3.212, 95% CI: 1.586-6.506, p = 0.001) were the independent risk factor of MT in patients undergoing LT. Conclusion: Patients receiving MT in perioperative periods of LT had worse short-term and long-term outcomes than the non-MT patients. Massive transfusion and acute rejection were significant risk factors affecting long-term survivals of LT patients, and intraoperative blood loss of over 1100 ml was the independent risk factor of MT in patients undergoing LT. The results may offer valuable information on perioperative management in LT recipients who experience high risk of MT.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Impact of Perioperative Massive Transfusion on Long Term Outcomes of Liver Transplantation: a Retrospective Cohort Study

Tan¹,

Xiao-zhen²,

Yue³

et al. 2021

Int. J. Med. Sci.

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show abstract

“…While risk ratios ranged from 1.01 to 1.14, it is unclear if other risk factors for increased bleeding and transfusion were fully accounted for. [16][17][18] For example, the mean MELD score ranged from 13.5 to 25 among the studies, indicating that the patient population varied widely. Another weakness was the wide variation in the mean volume of transfused PRBC, ranging from 2 to 16.9 units.…”

Section: Transfusion Requirementsmentioning

confidence: 99%

“…Several studies reported increased mortality among patients who had a higher PRBC transfusion rate. While risk ratios ranged from 1.01 to 1.14, it is unclear if other risk factors for increased bleeding and transfusion were fully accounted for 16–18 . For example, the mean MELD score ranged from 13.5 to 25 among the studies, indicating that the patient population varied widely.…”

Section: Question 1: What Is the Optimal Blood Replacement Therapy Pr...mentioning

confidence: 99%

“…Jozwik et al compared patients who experienced early biliary complications (n = 41) and those who did not (n = 198). 16 Of the entire study population, 45% of patients (115/239) did not receive any PRBC. A multivariable analysis showed no association between units of PRBC transfused and the incidence of biliary complications (2.1 vs. 1.7, p = NS).…”

Section: Biliary Complicationsmentioning

confidence: 99%

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Intraoperative transfusion management, antifibrinolytic therapy, coagulation monitoring and the impact on short‐term outcomes after liver transplantation—A systematic review of the literature and expert panel recommendations

Yoon,

Bartoszko,

Bezinover

et al. 2022

Clinical Transplantation

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Background Liver transplantation (LT) is frequently complicated by coagulopathy associated with end‐stage liver disease (ESLD), that is, often multifactorial. Objectives The objective of this systematic review was to identify evidence based intraoperative transfusion and coagulation management strategies that improve immediate and short‐term outcomes after LT. Methods PRISMA‐guidelines and GRADE‐approach were followed. Three subquestions were formulated. (Q); Q1: transfusion management; Q2: antifibrinolytic therapy; and Q3: coagulation monitoring. Results Sixteen studies were included for Q1, six for Q2, and 10 for Q3. Q1: PRBC and platelet transfusions were associated with higher mortality. The use of prothrombin complex concentrate (PCC) and fibrinogen concentrate (FC) were not associated with reductions in intraoperative transfusion or increased thrombotic events. The use of cell salvage was not associated with hepatocellular carcinoma (HCC) recurrence or mortality. Cell salvage and transfusion education significantly decreased blood product transfusions. Q2: Epsilon‐aminocaproic acid (EACA) and tranexamic acid (TXA) were not associated with decreased blood product transfusion, improvements in patient or graft survival, or increases in thrombotic events. Q3: Viscoelastic testing (VET) was associated with decreased allogeneic blood product transfusion compared to conventional coagulation tests (CCT) and is likely to be cost‐effective. Coagulation management guided by VET may be associated with increases in FC and PCC use. Conclusion Q1: A specific blood product transfusion practice is not recommended (QOE; low | Recommendation; weak). Cell salvage and educational interventions are recommended (QOE: low | Grade of Recommendation: moderate). Q2: The routine use of antifibrinolytics is not recommended (QOE; low | Recommendation; weak). Q3: The use of VET is recommended (QOE; low‐moderate | Recommendation; strong).

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Predictive role of hepatic venous pressure gradient in bleeding events among patients with cirrhosis undergoing orthotopic liver transplantation

Giabicani,

Joly,

Sigaut

et al. 2024

JHEP Reports

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Impact of Blood Loss and Intraoperative Blood Transfusion During Liver Transplantation on the Incidence of Early Biliary Complications and Mortality

Cited by 7 publications

References 9 publications

Impact of Perioperative Massive Transfusion on Long Term Outcomes of Liver Transplantation: a Retrospective Cohort Study

Impact of Perioperative Massive Transfusion on Long Term Outcomes of Liver Transplantation: a Retrospective Cohort Study

Intraoperative transfusion management, antifibrinolytic therapy, coagulation monitoring and the impact on short‐term outcomes after liver transplantation—A systematic review of the literature and expert panel recommendations

Predictive role of hepatic venous pressure gradient in bleeding events among patients with cirrhosis undergoing orthotopic liver transplantation

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