Intraoperative blood losses and transfusion requirements during adult liver transplantation remain difficult to predict

Steib, A.; Freys, G.; Lehmann, Catherine; Meyer, Christian; Mahoudeau, G.

doi:10.1007/bf03020372

Cited by 146 publications

(93 citation statements)

References 14 publications

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“…The results have not been homogenous as patient selection, surgical conditions, and intraoperative management vary from center to center. 5 With this study, we tried to identify preoperative variables with the ability to predict bleeding and intraoperative blood transfusion requirements for our adult OLT patients. We focused essentially on preoperative hematologic and coagulation tests.…”

Section: Discussionmentioning

confidence: 99%

Predictive Variables Affecting Transfusion Requirements in Orthotopic Liver Transplantation

Araújo

Cordeiro

Proença

et al. 2010

Transplantation Proceedings

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Introduction and aims. Adult orthotopic liver transplantation (OLT) is associated with considerable blood product requirements. The aim of this study was to assess the ability of preoperative information to predict intraoperative red blood cell (RBC) transfusion requirements among adult liver recipients. Methods. Preoperative variables with previously demonstrated relationships to intraoperative RBC transfusion were identified from the literature: sex, age, pathology, prothrombin time (PT), factor V, hemoglobin (Hb), and platelet count (plt). These variables were then retrospectively collected from 758 consecutive adult patients undergoing OLT from 1997 to 2007. Relationships between these variables and intraoperative blood transfusion requirements were examined by both univariate analysis and multiple linear regression analysis. Results. Univariate analysis confirmed significant associations between RBC transfusion and PT, factor V, Hb, Plt, pathology, and age (P values all Ͻ .001). However, stepwise backward multivariate analysis excluded variables Plt and factor V from the multiple regression linear model. The variables included in the final predictive model were PT, Hb, age, and pathology. Patients suffering from liver carcinoma required more blood products than those suffering from other pathologies. Yet, the overall predictive power of the final model was limited (R 2 ϭ .308; adjusted R 2 ϭ .30). Conclusion. Preoperative variables have limited predictive power for intraoperative RBC transfusion requirements even when significant statistical associations exist, identifying only a small portion of the observed total transfusion variability. Preoperative PT, Hb, age, and liver pathology seem to be the most significant predictive factors but other factors like severity of liver disease, surgical technique, medical experience in liver transplantation, and other noncontrollable human variables may play important roles to determine the final transfusion requirements.

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Section: Discussionmentioning

confidence: 99%

Predictive Variables Affecting Transfusion Requirements in Orthotopic Liver Transplantation

Araújo

Cordeiro

Proença

et al. 2010

Transplantation Proceedings

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“…Therefore, minimizing the need for blood product transfusion should be an important objective. We, 3 as well as others, [4][5][6] have experienced a progressive reduction in the use of most blood components during the last decade. This trend is caused by several factors, such as earlier patient selection, better preservation of grafts, more experienced surgical and anesthesiology teams, implementation of new techniques, 7 and use of drugs to improve hemostasis.…”

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confidence: 99%

Intraoperative red blood cell transfusion in liver transplantation: Influence on patient outcome, prediction of requirements, and measures to reduce them

Ramos

Dalmau

Sabaté

et al. 2003

Liver Transplantation

241

171

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Objectives of this study are to quantify the need for blood transfusion during liver transplantation (LT) and confirm the importance of intraoperative blood transfusion as an independent prognostic factor for postoperative outcome. Furthermore, we try to detect useful variables for the preoperative identification of patients likely to require transfusion of packed red blood cell units (PRCUs) and identify measures to reduce transfusion needs. Data were collected prospectively between September 1998 and November 2000. One hundred twenty-two LTs were included in the study. Forty-two patients (34%) did not require transfusion of PRCUs. In multivariate analysis, transfusion of more than three PRCUs was found to be the only significant variable associated with prolonged hospital stay. In addition, excluding perioperative deaths, PRCU transfusion, using a cutoff value of six units, was the only variable to reach statistical significance (P ‫؍‬ .008; risk ratio, 4.93; 95% confidence interval, 15 to 15.9) to predict survival in a multivariate analysis that also included Child's class and United Network for Organ Sharing (UNOS) classification. Moreover, only preoperative hemoglobin (Hb) level was found to significantly predict the need for transfusion of one or more PCRUs. Finally, only UNOS classification and placement of an intraoperative portacaval shunt were found to be statistically significant to predict the need to transfuse more than six PRCUs. We found the requirement of even a moderate number of blood transfusions is associated with longer hospital stay, and transfusion of more than six PRCUs is associated with diminished survival. Preoperative normalization of Hb levels and placement of an intraoperative portacaval shunt can diminish the number of blood transfusions during LT. (Liver Transpl 2003;9:1320-1327.)

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“…On the other hand, a recently published Cochrane review did not confirm the superiority of one technique over the other [30]. Other surgical factors related with increased blood transfusion during LT include a history of previous upper abdominal surgery, portal vein thrombosis and, in children, previous portoenterostomy [26,28]. Although the duration of surgery was identified as independent predictor of intraoperative blood loss and the amount of RBCs transfused, the exact direction of this relationship has not been established as longer surgery time may also be a indicator of increased intraoperative difficulties, which also could be a consequence of increased bleeding [20].…”

Section: Surgery-related Predictors Of Blood Transfusionmentioning

confidence: 98%

“…A single study has found that initial fibrinogen levels were associated with intraoperative blood loss and the amount of transfused RBCs [20]. In addition, the concentration of fibrin degradation products were independent predictors of high blood loss during LT [26].…”

Section: Recipient-related Predictors Of Blood Transfusionmentioning

confidence: 99%

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Perioperative bleeding in patients undergoing liver transplantation

Starczewska

Giercuszkiewicz²,

Niewiński³

et al. 2016

Anaesthesiol Intensive Ther

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Liver transplantation (LT) remains one of the most challenging surgical procedures. For many years uncontrolled bleeding and catastrophic haemorrhages were one of the major causes of perioperative mortality and morbidity. During the past fifty years, significant progress in surgical technique and perioperative management has led to a marked change in transfusion practice over time, where up to 79.6% of LTs in experienced transplant centers are performed without any blood product transfusion. Despite this, perioperative bleeding and transfusion requirements remain potent predictors of patient's mortality, as well as postoperative complications and graft survival. The major impact of blood product transfusion on LT recipients outcomes implies that all patients on waiting lists should be carefully screened for the presence of risk factors of perioperative bleeding. Although multiple predictors of transfusion requirements during recipients have been identified, no predictive model validated across centers has been constructed. The most suitable strategies to reduce intraoperative blood loss in this group should be employed on a case-to-case basis. This paper aims to summarize the most up-to-date evidence in the management of haemostasis in LT recipients.Key words: liver transplantation, perioperative management, haemostasis, bleeding Anaesthesiology Intensive Therapy 2016, vol. 48, no 1, 34-40 Liver transplantation (LT) remains one of the most challenging surgical technique. For many years, uncontrolled bleeding and catastrophic haemorrhages were one of the major causes of perioperative mortality and morbidity. During more than the fifty years of experience gained since the first LT was performed by Thomas Starzl in 1963, an improvement in surgical techniques and anaesthetic management has led to a marked change in transfusion practices over time. A recently published retrospective analysis of data from the Mayo Clinic in Rochester has shown that over the last two decades there has been a significant decrease in the amount of perioperatively transfused red blood cells (RBCs), fresh frozen plasma (FFP), platelets, cryoprecipitate and intraoperative autotransfusions [1]. Interestingly, this was noted despite the fact that transfusion triggers remained the same over time [1]. Massicotte et al. [2] reported that currently up to 79.6% of LTs are performed without any blood product transfusion. The major impact of blood product transfusion on LT recipient outcomes implies that all patients on waiting lists should be carefully screened for the presence of risk factors of perioperative bleeding. The most suitable strategies to reduce intraoperative blood loss in this group should be employed on a case-to-case basis. This paper aims to summarize the most up-to-date evidence in management of haemostasis in LT recipients. HAEMOSTATIC ALTERATIONS IN LIVER TRANSPLANT RECIPIENTSThe change in transfusion practices was possible due to a better understanding of alterations in the haemostatic system in LT recipients. The l...

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Intraoperative blood losses and transfusion requirements during adult liver transplantation remain difficult to predict

Cited by 146 publications

References 14 publications

Predictive Variables Affecting Transfusion Requirements in Orthotopic Liver Transplantation

Predictive Variables Affecting Transfusion Requirements in Orthotopic Liver Transplantation

Intraoperative red blood cell transfusion in liver transplantation: Influence on patient outcome, prediction of requirements, and measures to reduce them

Perioperative bleeding in patients undergoing liver transplantation

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