Intraoperative red blood cell transfusion in liver transplantation: Influence on patient outcome, prediction of requirements, and measures to reduce them

Abstract

Objectives of this study are to quantify the need for blood transfusion during liver transplantation (LT) and confirm the importance of intraoperative blood transfusion as an independent prognostic factor for postoperative outcome. Furthermore, we try to detect useful variables for the preoperative identification of patients likely to require transfusion of packed red blood cell units (PRCUs) and identify measures to reduce transfusion needs. Data were collected prospectively between September 1998 and November 2000. One hundred twenty-two LTs were included in the study. Forty-two patients (34%) did not require transfusion of PRCUs. In multivariate analysis, transfusion of more than three PRCUs was found to be the only significant variable associated with prolonged hospital stay. In addition, excluding perioperative deaths, PRCU transfusion, using a cutoff value of six units, was the only variable to reach statistical significance (P ‫؍‬ .008; risk ratio, 4.93; 95% confidence interval, 15 to 15.9) to predict survival in a multivariate analysis that also included Child's class and United Network for Organ Sharing (UNOS) classification. Moreover, only preoperative hemoglobin (Hb) level was found to significantly predict the need for transfusion of one or more PCRUs. Finally, only UNOS classification and placement of an intraoperative portacaval shunt were found to be statistically significant to predict the need to transfuse more than six PRCUs. We found the requirement of even a moderate number of blood transfusions is associated with longer hospital stay, and transfusion of more than six PRCUs is associated with diminished survival. Preoperative normalization of Hb levels and placement of an intraoperative portacaval shunt can diminish the number of blood transfusions during LT. (Liver Transpl 2003;9:1320-1327.)

Aplicação do escore MELD em pacientes submetidos a transplante de fígado: análise retrospectiva da sobrevida e dos fatores preditivos a curto e longo prazo

“…da morbidade e diminuição da sobrevida. Embora transfusões maciças ainda aconteçam, 10% a 50% das cirurgias de transplante cursam sem requerer transfusões de sangue (13,37,38,39,43) . No presente estudo, 8,62% dos pacientes não foram submetidos a transfusão sangüínea durante a realização do transplante de fígado.…”

“…A transfusão de mais de seis unidades de concentrados de hemácias tem sido relacionada à reduzida sobrevida após o transplante de fígado (43) . É notória a associação de politransfusão e complicação pós-operatória, mas poucos estudos têm demonstrado a associação de número de concentrados de hemácias transfundidas como fator preditivo de sobrevida.…”

“…Utilizou-se a classificação de Child-Turcotte, modificada por Pugh et al em 1973 (43) , para a colocação dos pacientes em lista única de espera de transplante de fígado (7) .…”

Major liver resection, systemic fibrinolytic activity, and the impact of tranexamic acid

“…[1][2][3][4][5] Despite many technical advances, intraoperative bleeding remains a problem during liver resection with 30-40% of patients receiving perioperative blood transfusions. [6][7][8] Blood transfusion carries several risks, including transfusion-transmitted viruses, transfusion-related acute lung injury, transfusion-associated circulatory overload, acute hemolytic transfusion reactions, bacterial contamination and severe allergic reactions.…”

Temporary portocaval shunt in orthotopic liver transplantation: Need for a standardized approach?

“…After the exclusion of duplicates, 4386 titles were obtained; 19 articles met all the criteria, but only in 11 of those articles was the experience with patients reported. Three articles were excluded as they were written by the same group of authors [5][6][7][8] in the same hospital during a similar time period, and although it was not specified, it was assumed that they described the results from the same cohort of patients who were more fully reported in other publications that were included in our analysis. Results from the 8 included articles are summarized in Tables 1 and 2, including a total of 2073 patients.…”