<p>A Single-Centre Review of Transfusion Practices and Blood Wastage in Liver Transplantation</p>

Abstract

Background: Liver transplantation is associated with massive blood loss due to a combination of coagulopathy, portal hypertension, and multiple vascular transection and anastomoses. Multiple blood transfusions over a short time frame may result in significant blood and component wastage due to over-ordering of blood products and component time expiry. Blood wastage in the setting of liver transplantation is yet to be reviewed. We reviewed transfusion practices during liver transplantation and audited blood component and product wastage. Methods: We performed a single-center retrospective review of all adult patients aged >16 years over a period of a year. A total of 181 cases were included in the review. Results: Eighty-seven percent of liver transplants were first transplants and were mainly due to chronic liver failure. Our cohort had a median blood loss of 4249 mL (IQR 2830, 6576) per transplant. Patients having redo procedures or have acute liver failure as a presenting aetiology bled significantly more. Nearly all our patients received blood products during the perioperative period. Fresh frozen plasma (FFP) was transfused in 91.2% of our cohort, followed by packed red cells (PRC, 64.2%), platelets (52.5%) and cryoprecipitates (32.0%). A total of 142 units of blood and blood product were wasted. This equates to a wastage rate of 4.6%. This is higher than the target of 3% set by our institution. Highest wastage rates were seen in FFP (8.6%), followed by PRC (2.2%), cryoprecipitates (1.0%) and platelets (0.9%). The commonest cause of wastage was "time expired". The total cost of wastage is £9800, which represents 3.3% of the total cost of blood products transfused. Conclusion: Changing blood component ordering habits, staff training, and awareness may help reduce wastage of this precious commodity.

Blood utilization in liver transplantation (BUILT): A multidisciplinary survey of transfusion practices

“…Limited data are available related to blood product wastage in the setting of liver transplant surgery. A retrospective study at one center that analyzed 181 liver transplant cases over a 1‐year period reported an overall blood wastage rate of 4.6% (142 total wasted units), with plasma showing the highest rate of wastage at 8.6%, mostly due to expiration after not being transfused 14 . Liver transplant surgeries impact blood bank operations in multiple ways, including the need for more staff and inventory on hand 12 …”

“…A retrospective study at one center that analyzed 181 liver transplant cases over a 1-year period reported an overall blood wastage rate of 4.6% (142 total wasted units), with plasma showing the highest rate of wastage at 8.6%, mostly due to expiration after not being transfused. 14 Liver transplant surgeries impact blood bank operations in multiple ways, including the need for more staff and inventory on hand. 12 As blood is a finite resource and shortages are more commonplace during the COVID-19 pandemic, liver transplant and PBM programs must make a concerted effort to conserve blood whenever possible.…”