Intraoperative Blood Loss in Pediatric Liver Transplantation

Abstract

The relative contribution of 14 preoperative risk factors to a high intraoperative blood loss was studied in 95 consecutive first pediatric orthotopic liver transplantations (OLT). Patients were distributed in two groups according to red blood cell (RBC) requirements. Wide interindividual RBC requirements were observed (median, 79 mL/kg; range, 4-586). The upper quartile of the population was defined as the high blood loss group and required 123 mL/kg or more (median, 161). On univariate analysis, the high blood loss group had a significantly higher proportion of patients with portal vein hypoplasia, intraabdominal malformations, signs of severe liver failure (encephalopathy, ascites, prolonged prothrombin time), and requiring inpatient support. Age, previous abdominal surgery, and platelet count had no prognostic value. All variables used in the univariate analysis were included in a stepwise logistic regression analysis. Only presence of portal vein hypoplasia, inpatient support, and use of a reduced-size liver graft were independently associated with a high blood loss. Adjusted odds ratios were 40.4 (95% confidence interval; 5.9-278), 5.4 (1.6-17.9), and 3.8 (0.9-15.2), respectively, highlighting the importance of portal vein hypoplasia as a risk factor for high blood loss.

Preoperative predictors of the need for allogeneic blood transfusion in lung cancer surgery

“…The analysis weakened the importance of other potentially influential variables, such as basal Hb, which was associated with ABT in previous studies 32 . Instead, our results singled out the previously unreported role of ESR as a predictive factor for ABT 25,27,28,31 . These data can be explained, respectively, by the rare presence of preoperative anemia in candidates for lung cancer surgery and by the importance of ESR as an inflammatory value 33–36 …”

“…The present study was aimed at recognizing the predictive factors of intraoperative and postoperative ABT in lung cancer surgery, with the objective of providing a guide to the use of blood‐sparing procedures, such as autotransfusion and/or the use of epoetin 5,8–11,15 . At the present time, in fact, models or values able to predict bleeding and/or ABT in other surgical conditions 25–31 may not easily be used in connection with lung cancer surgery.…”

“…Only 17.3 percent of all operations and 19.9 percent of resolvent surgeries required ABT. As in other circumstances, the need for transfusion was greatly influenced by the characteristics of the surgery, 25,28 such as the amount and/or the vascularization of tissue removed. Extensive resolvent surgery (pneumonectomy and resolvent surgery with costal resection), in fact, was the category of surgery burdened by a major requirement of ABT, and this association was independent of the tumor stage.…”

Preoperative Thromboelastometry as a Predictor of Transfusion Requirements during Adult Living Donor Liver Transplantation

“…However, this balance is unstable and can quickly decompensate, resulting in bleeding and thrombosis [5,6,7]. Therefore, the ability to predict intraoperative blood loss and transfusion requirements would be of great help to ensure adequate blood product supply and to enable appropriate therapy for patients at high bleeding risk [8,9,10,11]. This would also help anesthetists determining patients who are more likely to benefit from blood-salvaging techniques, prophylactic antifibrinolytic agents, and goal-directed therapy as an integral part of a patient blood management program [12,13,14,15,16].…”

Transcapsular arterial neovascularization of liver transplants increases the risk of intraoperative bleeding during retransplantation

“…High‐volume blood loss during liver transplantation (LTX) is a serious complication associated with increased mortality and morbidity . Individual needs for blood transfusions are difficult to predict preoperatively and profuse bleeding can have multiple causes . Among surgical causes, previous operation and retransplantation leading to intra‐abdominal adhesions have been identified as substantial risk factors .…”