Impact of Model for End-Stage Liver Disease Score on Transfusion Rates in Liver Transplantation

Varotti, Giovanni; Santori, Gregorio; Andorno, Enzo; Morelli, N; Ertreo, Marco; Strada, Paolo; Porcile, Elisa; Casaccia, M.; Centanaro, M.; Valente, Umberto

doi:10.1016/j.transproceed.2013.07.006

Cited by 11 publications

(14 citation statements)

References 16 publications

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“…6 The Model for End-Stage Liver Disease score is a known method of classifying disease severity, and higher Model for End-Stage Liver Disease scores may correlate with increased transfusion requirements. 9,13,17 Rana and associates found a positive association between warm ischemia time, bilirubin levels, and PRBC transfusion requirements. This study also showed that bleeding associated with prolonged native hepatectomy was strongly correlated with a patient history of previous major abdominal surgery.…”

Section: Introductionmentioning

confidence: 99%

“…1,3,5,[7][8][9][10] It is well documented that a major predictor of survival after OLT is the volume of transfused blood. 1,9,[11][12][13][14] Massive blood transfusion is commonly defined as transfusion of more than 6 U (> 2100 mL) of PRBCs within 24 hours of skin incision. 9,11,14 Multiple studies have demonstrated that patients who received massive blood transfusions during OLT have longer hospital stays, increased morbidity, and decreased survival rates.…”

Section: Introductionmentioning

confidence: 99%

“…9,11,14 Multiple studies have demonstrated that patients who received massive blood transfusions during OLT have longer hospital stays, increased morbidity, and decreased survival rates. 1,2,5,9,[11][12][13][14] Although advancements in anesthetic and surgical care have decreased intraoperative PRBC transfusion requirements, many liver transplant patients receive at least 1 U of PRBCs during surgery. 1,2,5,9,11,13,15 The administration of just 1 U has been associated with a 30% increase in morbidity in certain patient populations.…”

Section: Introductionmentioning

confidence: 99%

“…1,2,5,9,[11][12][13][14] Although advancements in anesthetic and surgical care have decreased intraoperative PRBC transfusion requirements, many liver transplant patients receive at least 1 U of PRBCs during surgery. 1,2,5,9,11,13,15 The administration of just 1 U has been associated with a 30% increase in morbidity in certain patient populations. 14 Many studies have investigated potential preoperative characteristics that are associated with massive blood loss and therefore necessitate massive blood transfusions in OLT.…”

Section: Introductionmentioning

confidence: 99%

“…14 Many studies have investigated potential preoperative characteristics that are associated with massive blood loss and therefore necessitate massive blood transfusions in OLT. 1,[4][5][6]9,[12][13][14][16][17][18][19] Factors investigated vary by study and institution but include laboratory values of the recipient and donor, medical history of the organ donor, and recipient preoperative characteristics. Mondanlou and associates found that a transplant recipient's preoperative creatinine level of greater than 1.3 mg/dL positively correlated with massive blood transfusion.…”

Section: Introductionmentioning

confidence: 99%

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2016

Exp Clin Transplant

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Objectives: The primary aim of this study was to determine whether specific preoperative clinical characteristics were associated with low-volume transfusion in liver transplant recipients. Low-volume transfusion was defined as transfusion of < 2100 mL of packed red blood cells intraoperatively during liver transplant. The ability to accurately predict lowvolume transfusion could increase patient safety, decrease complications associated with transfusion, improve blood management, and decrease transplant case cost. Materials and Methods: Data were retrieved by retrospective chart review of 266 patients who received a liver transplant at the Mayo Clinic (Jacksonville, FL, USA). The primary outcome was lowvolume transfusion. Associations of preoperative information with low-volume transfusion were explored using single-variable and multivariable logistic regression models; missing data were imputed with the sample median for continuous data and the most frequent category for categorical variables. Results: Low-volume transfusion occurred in 23% of first-time liver transplant recipients (62/266 patients; 95% confidence interval, 18%-29%). History of hepatitis C virus infection (P = .048), history of hepatocellular carcinoma (P = .050), short cold ischemia time (P = .006), and low international normalized ratio (P = .002) were independently associated with low-volume transfusion during liver transplant in a multivariable logistic regression model. Conclusions: Multiple studies have shown increased morbidity and mortality after orthotopic liver transplant when more than 6 U of packed red blood cells are administered within 24 hours of surgical incision. A method to identify low-volume transfusion candidates could help predict patient outcomes, decrease blood handling, and reduce costs. If patients with low-volume transfusion could be identified, fewer blood products would need to be prepared in advance. Although elevated preoperative coagulation parameters decrease the probability of low-volume transfusion, a definitive profile of a low-volume transfusion liver transplant recipient was not established.

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Section: Introductionmentioning

confidence: 99%