Risk Factors for Transfusion after Orthotopic Liver Transplantation

Abstract

<b><i>Background:</i></b> Transfusion of blood products during orthotopic liver transplantation (OLT) is associated with increased morbidity and mortality. Although risk factors associated with intraoperative transfusion requirements have been widely assessed, published data on the prediction of postoperative transfusion requirements are sparse. <b><i>Objectives:</i></b> The aim of this study was to evaluate risk factors for postoperative allogeneic transfusion requirements in OLT. <b><i>Methods:</i></b> Clinical characteristics and intraoperative parameters of 645 consecutive adult patients undergoing OLT were retrospectively reviewed. Multivariate logistic regression was used to determine the main determinants for postoperative transfusion requirements. <b><i>Results:</i></b> Determinants of postoperative transfusion requirements of any blood product in the postoperative period were the number of blood products transfused in the intraoperative period (OR 1.17, 95% CI 1.08–1.28), warm ischemia time (OR 1.05, 95% CI 1.02–1.08), MELD score (OR 1.05, 95% CI 1.01–1.08) and hepatocellular carcinoma (OR 0.45, 95% CI 0.28–0.72). A dose-dependent effect between the number of units transfused in the intraoperative period and transfusion requirements in the postoperative period was also observed. The relative risk of postoperative allogeneic transfusion of any blood component was 5.9 (95% CI 3.4–10.4) for patients who received 1–2 units in the intraoperative period, 7.3 (95% CI 3.6–14.7) for those who received 3–5 units in the intraoperative period, and 11.1 (95% CI 4.7–26.4) for those who received 6 or more units, when compared to no intraoperative blood transfusion. <b><i>Conclusion:</i></b> Our study demonstrated an association between intraoperative transfusion and warm ischemia time with postoperative transfusion requirements. The identification of risk factors for transfusion in the postoperative period may improve management of these patients by increasing awareness to bleeding complications in this high-risk population and by expanding hemostasis monitoring to the postoperative period.

Lack of alloimmunization to the D antigen in D‐negative orthotopic liver transplant recipients receiving D‐positive red blood cells perioperatively

“…Advances in surgical techniques and anaesthetic management have contributed to an overall reduction in the transfusion needs during and following liver transplantation. Despite blood management, liver transplantation is still associated with high blood transfusion requirements perioperatively because of abnormal haemostasis and bleeding complications [2,3]. D-negative patients are routinely transfused with D-negative red blood cells (RBCs) because of the high immunogenicity of the D antigen.…”

Preoperative portal vein recanalization–transjugular intrahepatic portosystemic shunt for chronic obliterative portal vein thrombosis: Outcomes following liver transplantation

“…This is of vital importance as increased transfusion of blood products is highly correlated with liver transplant morbidity and mortality. [ 28 ] Of note, FFP and cryoglobulin were also transfused more on average in the non‐PVR‐TIPS group. These differences may have been significant if our study had a higher sample size of patients to analyze.…”

Efficacy of intraoperative blood salvage and autotransfusion in living-donor liver transplantation: a retrospective cohort study

“…High intraoperative blood loss is anticipated during LT owing to coagulopathy, portal hypertension, collateral vessels, and complex surgical procedures including anastomosis of major vessels [1]. Therefore, allogeneic blood transfusion is common, and rates of perioperative allogeneic blood transfusion remain elevated in patients undergoing LT (50.5%-62.6%) [2,3]…”