Intraoperative blood loss and transfusion during primary pediatric liver transplantation: A single‐center experience

Abstract

Children undergoing liver transplantation are at a significant risk for intraoperative hemorrhage and thrombotic complications, we aim to identify novel risk factors for massive intraoperative blood loss and transfusion in PLT recipients and describe its impact on graft survival and hospital LOS. We reviewed all primary PLTs performed at our institution between September 2007 and September 2016. Data are presented as n (%) or median (interquartile range). EBL was standardized by weight. Massive EBL and MT were defined as greater than the 85th percentile of the cohort. 250 transplantations were performed during the study period. 38 (15%) recipients had massive EBL, and LOS was 31.5 (15‐58) days compared to 11 (7‐21) days among those without massive EBL (P < 0.001). MT median LOS was 34 (14‐59) days compared to 11 (7‐21) days among those without MT (P = 0.001). Upon backward stepwise regression, technical variant graft, operative time, and transfusion of FFP, platelet, and/or cryoprecipitate were significant independent risk factors for massive EBL and MT, while admission from home was a protective factor. Recipient weight was a significant independent risk factor for MT alone. Massive EBL and MT were not statistically significant for overall graft survival. MT was, however, a significant risk factor for 30‐day graft loss. PLT recipients with massive EBL or MT had significantly longer LOS and increased 30‐day graft loss in patients who required MT. We identified longer operative time and technical variant graft were significant independent risk factors for massive EBL and MT, while being admitted from home was a protective factor.

Impact of Perioperative Massive Transfusion on Long Term Outcomes of Liver Transplantation: a Retrospective Cohort Study

“…On the other hand, massive blood transfusion may aggravate the body's iron load and induce redox reaction by catalyzing the production of oxygen free radicals, thus damage renal tubular epithelial cells and raise the risk of acute kidney injury 19 - 21 . In contrast to earlier few findings 3 , 4 , however, we found MT may have adverse impact on long-term prognosis in LT patients. A possible explanation for this might be that massive blood transfusion associated complications may affect the functional recovery of LT recipients, thereby worsen long-term outcomes.…”

“…Nevertheless, massive transfusion (MT) during LT still remains common. The cause of MT during OLT is multifactorial 3 , 4 , the surgical reasons include major surgical hemorrhage, and hemostatic difficulty owing to lack of skilled surgical techniques, and the nonsurgical reasons are mainly coagulation dysfunction caused by coagulation factor deficiency, thrombocytopenia and hyperfibrinolysis.…”

Advancing Prediction of Risk of Intraoperative Massive Blood Transfusion in Liver Transplantation With Machine Learning Models. A Multicenter Retrospective Study

“…We consider that even if the result is based on the algorithm, it may have no significance in clinical practice, because in fact, the difference in WBC count between groups is not significant, and the mean values are within the normal range. The main non-surgical causes of MT during liver transplantation are coagulation dysfunction caused by coagulation factor deficiency, thrombocytopenia, and hyperfibrinolysis (Villarreal et al, 2019). Therefore, the conventional indicators of coagulation function are of great significance for the prediction of MT.…”

Establishing a Standardized Measure of Quality in Pediatric Liver Surgery: Definition and Validation of Textbook Outcome With Associated Predictors

“…Pediatric patients are particularly susceptible to blood loss and low circulating blood volume. Strong negative effects on the patients' outcome have been reported previously (10,36,37). Adverse effects of blood transfusions, such as lung injury, transfusion-related acute circulatory overload and hemolytic transfusion reactions, occur more often in pediatric patients than in the adult population, with associated mortality rates as high as 15-30% (36).…”