The Impact of Intraoperative Transfusion of Platelets and Red Blood Cells on Survival After Liver Transplantation

Boer, Marieke T. de; Christensen, Michael Cronquist; Asmussen, Mikael; Hilst, Christian S. van der; Hendriks, Herman G. D.; Slooff, Maarten J. H.; Porte, Robert J.

doi:10.1213/01.ane.0000289638.26666.ed

Cited by 302 publications

(224 citation statements)

References 45 publications

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“…This low proportion of patients with high scores likely contributed to minimize its overall accuracy for predicting survival after TH in this series. Intraoperative transfusion of red blood cells has often been related to lower survival after liver transplants 18,[25][26][27][28] , which can also be seen in this series, which identified a strong influence of the transfusion of blood components in the medium-term survival of transplant patients. This negative effect of blood transfusions probably stems from immunomodulation related to transfusions and changes of its components from storage process 29 , which may increase the risk of nosocomial infections, acute lung injury and development of autoimmune diseases in the long term 30 .…”

Section: Methods Methods Methods Methodssupporting

confidence: 63%

Emprego do escore MELD para a predição da sobrevivência pós-transplante hepático

Batista¹,

Sabat²,

Melo³

et al. 2012

Rev. Col. Bras. Cir.

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. We used analysis of area under ROC (receiver operating characteristic) as a summary measure of the performance of the MELD score and assessed predictors of medium-term survival using univariate and multivariate analysis. Results Results ResultsResults Results: The cumulative survival of three, six, 12 and 24 months of the 208 patients studied was 85.1%, 79.3%, 74.5% and 71.1%, respectively. The preoperative MELD score showed a low discriminatory power for predicting survival after TH. By univariate analysis, we identified intraoperative transfusion of red blood cells (p <0.001) and platelets (p = 0.004) and type of venous hepatocaval anastomosis (p = 0.008) as significantly related to medium-term survival of the patients studied. However, by multivariate analysis only red blood cell transfusion was a significant independent predictor of outcome. Conclusion Conclusion Conclusion Conclusion Conclusion: The MELD score showed low overall accuracy for predicting post-transplant survival of patients studied, among which only intraoperative transfusion of red blood cells was identified as an independent predictor of survival in the medium term after TH.

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Section: Methods Methods Methods Methodssupporting

confidence: 63%

Emprego do escore MELD para a predição da sobrevivência pós-transplante hepático

Batista¹,

Sabat²,

Melo³

et al. 2012

Rev. Col. Bras. Cir.

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“…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]. The exact mechanism linking increased mortality with blood transfusion is most likely multifactorial.…”

Section: Blood Transfusions and Patient Outcomesmentioning

confidence: 64%

“…The number of transfused RBCs units during LT is also a predictor of early surgical re-intervention, which in turn increases postoperative mortality three-fold [17]. RBCs transfusion is also negatively correlated with graft survival during the 1 and 5 year follow-ups [14].…”

Section: Blood Transfusions and Patient Outcomesmentioning

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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“…Target hemoglobin level was not less than 7.0 g/dL. 9 Fresh frozen plasma was used when the international normalized ratio was greater than 1.5.9 Early mortality was defined as recipients dying during the first 3 months after a liver transplant. 10 Estimated glomerular filtration rate was calculated using the Cockcroft-Gault method: estimated glomerular filtration rate = (140-age) × weight/creatinine × 72 × 0.85 (if female).…”

Section: Methodsmentioning

confidence: 99%

Untitled

Wen²,

Yan³

et al. 2015

Exp Clin Transplant

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Objectives: We sought to identify the risk factors associated with the early mortality after a livingdonor liver transplant. Materials and Methods: Two hundred eighteen patients were recruited in this study. Potential risk factors were analyzed using univariate and multivariate analyses. A C statistic equivalent to the area under the receiver operating characteristic curve was used to assess the ability of the model to predict mortality risk during the first 3 months after a living-donor liver transplant. Results: Twenty-six recipients died within the first 3 months after a living-donor liver transplant. On a multivariate analysis, intraoperative allogeneic red blood cell transfusion and the preoperative creatinine levels were independently associated with early postoperative mortality. A prognostic model was proposed in this study (early mortality risk score = 0.107 × intraoperative allogeneic red blood cells transfusion [U] + 0.005 × preoperative creatinine concentration [μmol/L]). Three-month survival rates of patients with high and low scores were 69.8% and 95.5% (P < .001). Conclusions: Transfusion of intraoperative allogeneic red blood cell and preoperative creatinine levels are associated with the early mortality after living-donor liver transplant. A model to predict early mortality after a living-donor liver transplant based on these risk factors was proposed in this study.

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The Impact of Intraoperative Transfusion of Platelets and Red Blood Cells on Survival After Liver Transplantation

Abstract: This retrospective study indicates that, in addition to RBC, platelet transfusions are an independent risk factor for survival after OLT. These findings have important implications for transfusion practice in liver transplant recipients.

Cited by 302 publications

References 45 publications

Emprego do escore MELD para a predição da sobrevivência pós-transplante hepático

Emprego do escore MELD para a predição da sobrevivência pós-transplante hepático

Perioperative bleeding in patients undergoing liver transplantation

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