Prediction of Intraoperative Transfusion Requirements During Orthotopic Liver Transplantation and the Influence on Postoperative Patient Survival

Abstract

Prediction of intraoperative blood product requirements based on preoperatively available variables is unreliable; however, there is a strong measurable association between transfusion and postoperative mortality.

Preoperative thrombelastography maximum amplitude predicts massive transfusion in liver transplantation

“…Using an alternative definition of 6 or more RBC units in 24 hours following surgery, McCluskey et al (22) were able to identify 7 preoperative variables—including INR and platelet count—to reliably predict a massive transfusion. However, other investigators using higher cut offs of 20+ or 30+ RBC units found an association with an elevated INR and low platelet count when predicting massive blood product utilization, but these variables lacked significance after adjusting for confounders(6). While these studies have large numbers of patients included in their analysis, they employed databanks of patients over decades in which the surgical techniques were diverse.…”

“…Risk of blood product use in transplant has been associated with an elevated international normalized ratio of prothrombin time (INR) and low platelet count(6), but these have limitations for predicting bleeding risk in patients with liver disease(7). The shortcoming of using these traditional coagulation assays is partitioning the coagulation system into plasma and cellular components.…”

A quantitative model to predict blood use in adult orthotopic liver transplantation

“…Bootstrap aggregation was performed in the training set similarly to the work by Cywinski et al to select independent predictors for the use of any blood product [26]. Briefly, the training set was sampled with replacement and variables with p < 0.1 on univariate analysis were entered into a logistic regression model using the backward stepwise method and were retained in the model if p < 0.05. cMELD score and its three components were analyzed separately due to strong interactions.…”

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].…”

“…Furthermore, it may help to reduce the quantity of blood prepared and reserved for patients at low risk of transfusion requirement with subsequent decrease in activity-based costs [17,18,19]. For all these reasons, several attempts have been made to identify patients at high risk for bleeding and to define preoperative factors which could help identifying them [10,11,20,21]. …”