Intraoperative Cryoprecipitate Transfusion and Its Association with the Incidence of Biliary Complications after Liver Transplantation-A Retrospective Cohort Study

Abstract

BackgroundCryoprecipitate is largely used for acquired hypofibrinogenemia in the setting of massive hemorrhage in liver transplantation (LT). However, the influence of intraoperative cryoprecipitate transfusion on biliary complications (BC) after LT has not been studied in detail.Study Design and MethodsIn a series of 356 adult patients who received their first LT, the causes of BC were retrospectively studied by multivariate logistic regression analysis. The clinical relationship between intraoperative cryoprecipitate transfusion and BC occurrence was studied through a retrospective cohort study in patients. All patients received follow-ups for one year, and, during the follow-up period, the time of BC occurrence and liver biopsies were recorded.ResultsIntraoperative cryoprecipitate transfusion (RR = 3.46, 95% CI [1.72–6.97], P<0.001), cold ischemia time >8 h (RR = 4.24, 95% CI [2.28–7.92], P<0.01), and high-level Child-Pugh ( RR = 1.71, 95% CI [1.11–2.63], P = 0.014) are independent risk factors to predict BC after LT according to time-to-event analysis. One year BC-free survival probability of patients received intraoperative cryoprecipitate transfusions was significantly lower when compared to the group that received no cryoprecipitate(P<0.001). Moreover, BC patients in the cryoprecipitate transfusion group owned different liver pathological feature, pathological micro-thrombus formation and cholestasis were seen more often (41.4% vs 0%, 62.1% vs 12.5%, respectively) than no cryoprecipitate transfusion group.ConclusionThese findings suggested that intraoperative cryoprecipitate transfusion was associated with BC after LT. The mechanism of BC occurrence might involve micro-thrombus formation and immune rejection.

The efficacy and safety of cryoprecipitate in the treatment of acquired hypofibrinogenaemia

“…Cryoprecipitate has an excellent safety profile in the UK, with the Serious Hazards of Transfusion report 2012 detailing only one serious adverse reaction to cryoprecipitate as part of a massive transfusion. Similarly, our current study noted no adverse events related directly to cryoprecipitate administration, though it did not address some recent concerns about biliary complications post‐liver transplantation (Liu et al , ).…”

Cryoprecipitate therapy

“…One study investigated the use of cryoprecipitate for acquired hypofibrinogenaemia after massive haemorrhage in LT. 66 The study found that intraoperative transfusion of cryoprecipitate was associated with biliary complications, a significant source of patient morbidity and mortality in patients undergoing LT. The authors concluded that cryoprecipitate should only be used in this setting after careful consideration.…”

“…73 There have also been reports implicating cryoprecipitate in cases of acute anaphylactic shock, pulmonary oedema, intravascular haemolysis, and biliary complications. 42 66 74 FFP transfusion in non-massively transfused trauma patients has been shown to be associated with adverse events in a dose-dependent manner; 75 the same can be assumed to be true for cryoprecipitate. However, given that an adult dose of cryoprecipitate of ∼10 U is sourced from multiple donors, it carries a greater risk of viral transmission per dose.…”

Retraction: Intraoperative Cryoprecipitate Transfusion and Its Association with the Incidence of Biliary Complications after Liver Transplantation-A Retrospective Cohort Study

“…Concerns have been raised that the transplants performed in the local context at the time of procedures reported in this article [1] may have involved organs/tissues procured from prisoners [2].…”

“…International ethics standards call for transparency in organ donor and transplantation programs and clear informed consent procedures including considerations to ensure that donors are not subject to coercion. Details as to the donor sources and methods of obtaining informed consent from donors were not reported in [1]. In response to the journal’s queries about these issues, the first author noted that the authors had access only to limited donor details (age, gender, blood type) in the clinical database used for this retrospective study, and that all transplants investigated in this study used organs/tissues from cardiac death donors that were 18 years or older.…”