MELD Score and Blood Product Requirements During Liver Transplantation: No Link

Massicotte, Luc; Beaulieu, Danielle; Roy, Jean‐Philippe; Marleau, Denis; Vandenbroucke, Frank; Dagenais, Michel; Lapointe, Réal; Roy, André

doi:10.1097/tp.0b013e3181a5e5f1

Cited by 76 publications

(59 citation statements)

References 38 publications

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“…These complications are caused mainly by massive haemorrhage and the pathophysiological features of the anhepatic stage, including the clamping of the great vessels and the congestion of internal organs. Similarly, a previous study by Massicotte et al,10 demonstrated no difference in the volume of bleeding during surgery and the volume of blood components transfused between two groups, divided based on the median MELD score value (21 points). The relationship between MELD score and transfusion requirements during liver transplantation is controversial.…”

Section: Discussionmentioning

confidence: 99%

Does the Model for End-Stage Liver Disease Score Predict Transfusion Amount, Acid-Base Imbalance, Haemodynamic and Oxidative Abnormalities during Living Donor Liver Transplantation?

Lee

Chung

2011

J Int Med Res

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The model for end-stage liver disease (MELD) score is associated with the severity of liver failure in transplant patients. This study examined whether life-threatening stress factors during liver transplantation differed according to the patients' preoperative MELD scores. Fortyfour patients who underwent living donor liver transplantation were divided into a high MELD group (MELD score ≥ 20) (n = 25) and a low MELD group (MELD score < 20) (n = 19). The volume of blood components transfused, acid-base homeostasis variables, and haemodynamic and oxidative variables were measured at each stage of the surgery. The systemic vascular resistance index was significantly lower in the high MELD group than in the low MELD group at all time points. The oxygen utility index and the oxygen extraction ratio were all significantly lower in the high MELD group than in the low MELD group only at the preanhepatic stage and not at later stages of surgery. Intraoperative transfusion volume and the severity of metabolic acidosis were not associated with the preoperative MELD score.

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Section: Discussionmentioning

confidence: 99%

Does the Model for End-Stage Liver Disease Score Predict Transfusion Amount, Acid-Base Imbalance, Haemodynamic and Oxidative Abnormalities during Living Donor Liver Transplantation?

Lee

Chung

2011

J Int Med Res

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“…Importantly, the extent of the coagulopathy or the severity of liver failure as assessed by the model of end-stage liver disease (MELD) score does not predict the proportion of patients who do require perioperative transfusion. 80 We believe that a major surgical procedure such as liver transplantation would never be possible in a patient with a true coagulopathic state, such as a patient with hemophilia, without correction of the coagulopathy with factor concentrates or blood product transfusion. (B and table), concomitant changes in pro-and antihemostatic pathways result in a "rebalance" in the hemostatic system.…”

Section: Clinical Evidence For Rebalanced Hemostasis In Liver Diseasementioning

confidence: 99%

Rebalanced hemostasis in patients with liver disease: evidence and clinical consequences

Lisman

Porte

2010

Blood

569

541

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Patients with liver disease frequently acquire a complex disorder of hemostasis secondary to their disease. Routine laboratory tests such as the prothrombin time and the platelet count are frequently abnormal and point to a hypocoagulable state. With more sophisticated laboratory tests it has been shown that patients with liver disease may be in hemostatic balance as a result of concomitant changes in both pro-and antihemostatic pathways. Clinically, this rebalanced hemostatic system is reflected by the large proportion of patients with liver disease who can undergo major surgery without any requirement for blood product transfusion. However, the hemostatic balance in the patient with liver disease is relatively unstable as evidenced by the occurrence of both bleeding and thrombotic complications in a significant proportion of patients. Although it is still common practice to prophylactically correct hemostatic abnormalities in patients with liver disease before invasive procedures by administration of blood products guided by the prothrombin time and platelet count, we believe that this policy is not evidence-based. In this article, we will provide arguments against the traditional concept that patients with liver failure have a hemostasis-related bleeding tendency. Consequences of these new insights for hemostatic management will be discussed. (Blood. 2010;116(6):878-885)

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“…In addition, the impact of the severity of the disease assessed with the Child-Pugh score and Model of End-Stage Liver Disease (MELD) score was frequently studied, yielding inconsistent results. Although Mangus et al [20] have suggested that the MELD score is an independent predictor of intraoperative blood loss, as well as the number of RBCs transfused, this has not been confirmed in subsequent studies [21]. Interestingly, Roullet et al have demonstrated that the Child-Pugh class, but not MELD score is an independent predictor of transfusion requirements [22].…”

Section: Recipient-related Predictors Of Blood Transfusionmentioning

confidence: 89%

Perioperative bleeding in patients undergoing liver transplantation

Starczewska

Giercuszkiewicz²,

Niewiński³

et al. 2016

Anaesthesiol Intensive Ther

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Liver transplantation (LT) remains one of the most challenging surgical procedures. For many years uncontrolled bleeding and catastrophic haemorrhages were one of the major causes of perioperative mortality and morbidity. During the past fifty years, significant progress in surgical technique and perioperative management has led to a marked change in transfusion practice over time, where up to 79.6% of LTs in experienced transplant centers are performed without any blood product transfusion. Despite this, perioperative bleeding and transfusion requirements remain potent predictors of patient's mortality, as well as postoperative complications and graft survival. The major impact of blood product transfusion on LT recipients outcomes implies that all patients on waiting lists should be carefully screened for the presence of risk factors of perioperative bleeding. Although multiple predictors of transfusion requirements during recipients have been identified, no predictive model validated across centers has been constructed. The most suitable strategies to reduce intraoperative blood loss in this group should be employed on a case-to-case basis. This paper aims to summarize the most up-to-date evidence in the management of haemostasis in LT recipients.Key words: liver transplantation, perioperative management, haemostasis, bleeding Anaesthesiology Intensive Therapy 2016, vol. 48, no 1, 34-40 Liver transplantation (LT) remains one of the most challenging surgical technique. For many years, uncontrolled bleeding and catastrophic haemorrhages were one of the major causes of perioperative mortality and morbidity. During more than the fifty years of experience gained since the first LT was performed by Thomas Starzl in 1963, an improvement in surgical techniques and anaesthetic management has led to a marked change in transfusion practices over time. A recently published retrospective analysis of data from the Mayo Clinic in Rochester has shown that over the last two decades there has been a significant decrease in the amount of perioperatively transfused red blood cells (RBCs), fresh frozen plasma (FFP), platelets, cryoprecipitate and intraoperative autotransfusions [1]. Interestingly, this was noted despite the fact that transfusion triggers remained the same over time [1]. Massicotte et al. [2] reported that currently up to 79.6% of LTs are performed without any blood product transfusion. The major impact of blood product transfusion on LT recipient outcomes implies that all patients on waiting lists should be carefully screened for the presence of risk factors of perioperative bleeding. The most suitable strategies to reduce intraoperative blood loss in this group should be employed on a case-to-case basis. This paper aims to summarize the most up-to-date evidence in management of haemostasis in LT recipients. HAEMOSTATIC ALTERATIONS IN LIVER TRANSPLANT RECIPIENTSThe change in transfusion practices was possible due to a better understanding of alterations in the haemostatic system in LT recipients. The l...

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MELD Score and Blood Product Requirements During Liver Transplantation: No Link

Cited by 76 publications

References 38 publications

Does the Model for End-Stage Liver Disease Score Predict Transfusion Amount, Acid-Base Imbalance, Haemodynamic and Oxidative Abnormalities during Living Donor Liver Transplantation?

Does the Model for End-Stage Liver Disease Score Predict Transfusion Amount, Acid-Base Imbalance, Haemodynamic and Oxidative Abnormalities during Living Donor Liver Transplantation?

Rebalanced hemostasis in patients with liver disease: evidence and clinical consequences

Perioperative bleeding in patients undergoing liver transplantation

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