Intraoperative Massive Transfusion Decreases Survival After Liver Transplantation

Boin, I.F.S.F.; Leonardi, M.I.; Luzo, Ângela Cristina Malheiros; Cardoso, Alisson C.; Caruy, C.A.; Leonardi, Luiz Sérgio

doi:10.1016/j.transproceed.2008.02.058

Cited by 74 publications

(64 citation statements)

References 12 publications

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“…Adverse outcomes include immediate and delayed immune and nonimmune reactions. A growing body of evidence suggests that allogenic blood and products are associated with excess short and longer-term morbidity (reduced graft function, infection, renal injury, re-operation) and mortality in LT [11,12] . It is difficult to exclude the possibility that RBC transfusion might be a surrogate marker for other underlying causes of poor outcome.…”

Section: Drivers For Transfusion-free Transplantationmentioning

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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Section: Drivers For Transfusion-free Transplantationmentioning

confidence: 99%

Reducing transfusion requirements in liver transplantation

Donohue

Mallett

2015

WJT

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“…2,4 Additionally, liver transplant patients are at risk for major blood loss during surgery, because of severe coagulopathies. 5 Several studies have indicated that allogenic red blood cell (RBC) transfusion is an independent risk factor for adverse events in the recipient; these events include infection, immunologic complications, and multiple organ failure, leading to a higher mortality rate. 6,7 These data apply to trauma, cardiac, and long-term intensive care unit (ICU) patients.…”

Section: Introductionmentioning

confidence: 99%

Effects of Blood Products on Nosocomial Infections in Liver Transplant Recipients

Özkardeşler

Avkan-Oğuz²,

Akan³

et al. 2013

Exp Clin Transplant

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Objectives: Infection is the most severe complication after an organ transplant. Blood cell transfusion is an independent risk factor for adverse events, including infection in the recipient. This study sought to evaluate the effect of blood product transfusions on nosocomial infections in liver transplant patients. Materials and Methods: Patients who underwent a liver transplant at our hospital between 2003 and 2010 were recruited for this study. Exclusion criteria were incomplete records, patients who were hospitalized for more than 48 hours during the 4 weeks before transplant, and pediatric transplants. Incidence of nosocomial infections, which were defined as infections occurring within 30 days after transplant was the primary endpoint. Results: The incidence of nosocomial infections was 28.7%. The number of transfusions of packed red blood cells and fresh frozen plasma was significantly higher in patients with nosocomial infection compared with patients without nosocomial infection (P = .018 and P = .039). Blood products dose-dependently contributed to nosocomial infections. Transfusions of ≥ 7.5 units of red blood cells (odds ratio: 2.8) or ≥ 12.5 units of fresh frozen plasma (odds ratio: 3.27) were associated with nosocomial infections (P = .042 and P = .015). The infection-related mortality rate was 10.3%. Conclusions: Blood product transfusions are associated with an increased rate of nosocomial infections, which contributes to higher morbidity and mortality.

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“…Blood transfusion has proved to be a significant risk factor for increased mortality after LT [2,11]. Intraoperative transfusion of at least 6 units of RBCs decreases survival rates during medium and longterm follow-up [12]. A similar pattern was observed in the transfusion of any amount of FFP and platelets, irrespectively of the amount of transfused RBCs [13,14].…”

Section: Blood Transfusions and Patient Outcomesmentioning

confidence: 81%

“…Amongst graft-related variables, the donor's older age is associated with a higher risk of massive transfusion [12]. The use of living donor grafts is also considered an independent predictor of RBCs transfusion, an aspect which has been well demonstrated in the paediatric population [31].…”

Section: Graft-related Predictors Of Blood Transfusionmentioning

confidence: 99%

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 Massive Transfusion Decreases Survival After Liver Transplantation

Cited by 74 publications

References 12 publications

Reducing transfusion requirements in liver transplantation

Reducing transfusion requirements in liver transplantation

Effects of Blood Products on Nosocomial Infections in Liver Transplant Recipients

Perioperative bleeding in patients undergoing liver transplantation

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