Relationship between Stroke Volume Variation and Blood Transfusion during Liver Transplantation

Abstract

Background. Intraoperative blood transfusion increases the risk for perioperative mortality and morbidity in liver transplant recipients. A high stroke volume variation (SVV) method has been proposed to reduce blood loss during living donor hepatectomy. Herein, we investigated whether maintaining high SVV could reduce the need for blood transfusion and also evaluated the effect of the high SVV method on postoperative outcomes in liver transplant recipients.Methods. We retrospectively analyzed 332 patients who underwent liver transplantation, divided into control (maintaining <10% of SVV during surgery) and high SVV (maintaining 10-20% of SVV during surgery) groups. We evaluated the blood transfusion requirement and hemodynamic parameters, including SVV, as well as postoperative outcomes, such as incidences of acute kidney injury, durations of postoperative intensive care unit and hospital stay, and rates of 1-year mortality.Results. Mean SVV values were 7.0% ± 1.3% in the control group (n = 288) and 11.2% ± 1.8% in the high SVV group (n = 44). The median numbers of transfused packed red blood cells and fresh frozen plasmas in the high SVV group were significantly lower than those in control group (0 vs. 2 units, P = 0.003; and 0 vs. 3 units, P = 0.033, respectively). No significant between-group differences were observed for postoperative outcomes.Conclusions. Maintaining high SVV can reduce the blood transfusion requirement during liver transplantation without worsening postoperative outcomes. These findings provide insights into improving perioperative management in liver transplant recipients.

Restrictive fluid management strategies and outcomes in liver transplantation: a systematic review

“…38,[40][41][42]44,49,67 Three intraoperative studies and one perioperative study did not show any effect. 41,44,49,67 One study reported that a restrictive strategy significantly increased the need for RRT (not supported by our calculated OR; see Table 2). 38 One before-after intraoperative study showed a higher incidence of AKI in the restrictive group This study is a three-arm study.…”

“…We found 29 observational cohort studies, with all except two studies 40,43 being considered at high or critical RoB. Among the 14 exposure-based cohort studies, [38][39][40][41][42][43][44][45][46][47][48][49][50][51] nine collected data from the intraoperative period: three compared low CVP with another strategy (one compared two centres using different protocols 38 ; one compared two groups retrospectively classified as to CVP values after reperfusion 39 ; and one compared low CVP with goaldirected therapy in a before-after study) 40 ; one compared stroke volume variation (SVV) goal-directed therapy with high-CVP management 41 ; two from the same centre compared the use of phlebotomies with either unmatched historical controls (before-after study) 42 or contemporary controls 43 ; two compared two retrospectively classified groups (one based on SVV 44 and one based on the volume of fluid received) 45 ; and one compared two groups in a before-after study (practice changed over time toward a more restrictive approach). 46 Three studies collected data for the complete perioperative period (intraoperative and postoperative periods): two before-after studies compared patients receiving a restrictive fluid management (either restrictive goal-directed therapy 47 or a fast-track bundle that included restricting fluid) 48 with unmatched historical controls and one compared two retrospectively classified albumin-treated groups.…”

“…34 The second RCT performed during the postoperative period reported a comparable three-month mortality between three different groups. 36 Among the twelve cohort studies reporting data on mortality, eleven studies did not show any effect [38][39][40][41][42]44,[47][48][49][50]67 and one study reported a lower one-year mortality with the use of intraoperative phlebotomy as part of a restrictive strategy (OR, 0.50; 95% CI, 0.27 to 0.92) 43 (eTable 3a).…”

“…Nine observational studies reported ICU LOS [38][39][40]44,[47][48][49][50]67 and six of them showed no effect. 39,40,44,47,50,67 One intraoperative study suggested an increased LOS with the use of a restrictive fluid management strategy even though they reported it as nonsignificant 38 and two intraoperative and postoperative studies suggested a decreased LOS 48,49 with the use of a restrictive fluid management strategy (eTable 3h).…”

Adverse transfusion reactions in patients with liver disease

“…Patients with severe liver disease have a greater risk of bleeding. In cases involving gastrointestinal bleeding, coagulopathies (Tripodi & Mannucci, 2011), gastrointestinal procedures (Yates et al, 2016) or liver transplantation (Choi et al, 2016), transfusions are often needed, and adverse transfusion reactions (AR) may occur in these recipients.…”