Predictive Modeling of Massive Transfusion Requirements During Liver Transplantation and Its Potential to Reduce Utilization of Blood Bank Resources

Abstract

When clinical and laboratory parameters are included, a model predicting intraoperative MT in patients undergoing liver transplantation is sufficiently accurate that its predictions could guide the blood order schedule for individual patients based on institutional data, thereby reducing the impact on blood bank resources. Ongoing evaluation of model accuracy and transfusion practices is required to ensure continuing performance of the predictive model.

The use of viscoelastic haemostatic assays in the management of major bleeding

“…Viscoelastic haemostatic assays have a better predictive value for bleeding in liver disease (Fayed et al , ; Tafur et al , ; Pustavoitau et al , ) and re‐bleeding than SLTs (Chau et al , ). A retrospective, single centre study comparing SLT and ROTEM in post‐operative bleeding in adult liver transplant (LT) patients found that several ROTEM parameters predicted bleeding (cut‐offs shown in brackets): EXTEM CT (≥65 s), INTEM CFT (≥181 s), FIBTEM A10 (≤13 mm) and FIBTEM MCF (≤15 mm) (AUC 0·682, 0·615, 0·615 and 0·611 respectively) compared to no SLT tests (Dotsch et al , ).…”

Predicting packed red blood cell transfusion in living donor liver transplantation: A retrospective analysis

“…There is a lot of heterogeneity with regard to the transfusion trigger and the number of units of PRBC transfusion analysed. [ 14 15 16 17 18 19 ] For example, Roullet et al . [ 16 ] had analysed the predictors for more than 1 volume of blood loss and Steib et al .…”

“…On univariate analysis of baseline TEG, deranged R time, MA as well as alpha angle were associated with greater PRBC transfusion as has been shown earlier. [ 17 ]…”

Incidence of Bleeding and Thrombosis in Patients with Liver Disease

“…Recent large series have reported intraoperative transfusion requirements of > 20 units of RBC in 19% of patients, 39 or 30% requiring > 10 units. 40 Postoperative hemorrhage requiring operative reintervention has been reported at similar rates, and is clearly associated with reduced patient survival. 41…”

“…Comparative illustration of (A) overall mortality and proportion of deaths attributed to bleeding and (B) site of fatal bleeding in two independent cohorts over time (1967-1974 and 1998-2016). Developed from Pustavoitau et al 40 and Schrem et al 41 . GI, gastrointestinal; ICH, intracranial hemorrhage; ICP intracranial pressure; SDH, subdural hematoma.…”