Predictors of intraoperative massive transfusion in orthotopic liver transplantation

• Published in: Transfusion (Philadelphia, Pa.) Pa.), 2024-01, Vol.64 (1), p.68-76
• Main Authors: Alhamar, Mohamed, Uzuni, Ajna, Mehrotra, Harshita, Elbashir, Jaber, Galusca, Dragos, Nagai, Shunji, Yoshida, Atsushi, Abouljoud, Marwan S., Otrock, Zaher K.
• Format: Article
• Language: English
• Subjects: Abdominal surgery; Adolescent; Adult; Aged; Blood banks; Blood Loss, Surgical; Blood Transfusion; Blood transfusions; Correlation coefficient; Correlation coefficients; Demographic variables; End Stage Liver Disease - surgery; Erythrocytes; Female; Hemoglobin; Hemoglobins - analysis; Humans; intraoperative; Ischemia; Liver; Liver diseases; liver transplant; Liver Transplantation; Liver transplants; Male; massive transfusion; Middle Aged; Multivariate analysis; Platelets; predictors; Retrospective Studies; Severity of Illness Index; Statistical analysis; Surgery; Transfusion; Transplantation; Young Adult
• ISSN: 0041-1132; 1537-2995
• DOI: 10.1111/trf.17600

Background Although transfusion management has improved during the last decade, orthotopic liver transplantation (OLT) has been associated with considerable blood transfusion requirements which poses some challenges in securing blood bank inventories. Defining the predictors of massive blood transfusion before surgery will allow the blood bank to better manage patients' needs without delays. We evaluated the predictors of intraoperative massive transfusion in OLT. Study Design and Methods Data were collected on patients who underwent OLT between 2007 and 2017. Repeat OLTs were excluded. Analyzed variables included recipients' demographic and pretransplant laboratory variables, donors' data, and intraoperative variables. Massive transfusion was defined as intraoperative transfusion of ≥10 units of packed red blood cells (RBCs). Statistical analysis was performed using SPSS version 17.0. Results The study included 970 OLT patients. The median age of patients was 57 (range: 16–74) years; 609 (62.7%) were male. RBCs, thawed plasma, and platelets were transfused intraoperatively to 782 (80.6%) patients, 831 (85.7%) patients, and 422 (43.5%) patients, respectively. Massive transfusion was documented in 119 (12.3%) patients. In multivariate analysis, previous right abdominal surgery, the recipient's hemoglobin, Model for End Stage Liver Disease (MELD) score, cold ischemia time, warm ischemia time, and operation time were predictive of massive transfusion. There was a direct significant correlation between the number of RBC units transfused and plasma (Pearson correlation coefficient r = .794) and platelets (r = .65). Discussion Previous abdominal surgery, the recipient's hemoglobin, MELD score, cold ischemia time, warm ischemia time, and operation time were predictive of intraoperative massive transfusion in OLT.