The impact of perioperative transfusion of blood products on survival after pediatric liver transplantation

Abstract

Intraoperative transfusion of red blood cells (RBC) is associated with adverse outcome after LT in adult patients. This relationship in pediatric patients has not been studied in depth, and its analysis is the scope of this study. Forty-one variables associated with outcome, including blood product transfusions, were studied in a cohort of 243 pediatric patients undergoing a cadaveric LT between 2002 and 2009 at the General Hospital of Bergamo. Multivariate stepwise Cox proportional hazards models were adopted with adjustment by propensity scores to minimize factors associated with the use of blood products. Median age at transplant was 1.37 yr. In uni- and multivariate analyses, perioperative transfusion of FFP and RBC was an independent risk factor for predicting one-yr patient and graft survival. The effect on one-yr survival was dose-related with a hazard ratio of 3.15 for three or more units of RBC (p = 0.033) and 3.35 for three or more units of FFP (p = 0.021) when compared with 1 or no units transfused. The negative impact of RBC and FFP transfusion was confirmed by propensity score-adjusted analysis. These findings may have important implications for transfusion practice in the LT pediatric recipients.

Bleeding and thrombotic complications of pediatric liver transplant

“…2–6,8–13,30 The incidence of bleeding in our cohort was also higher than what has been reported previously (20.7% vs. 5–15%), 11–13,30 but bleeding is reported inconsistently in prior cohorts and definitions vary, making the comparison difficult. Despite bleeding and thrombosis being similarly frequent events in our cohort, only thrombotic complications were associated with patient mortality.…”

“…Overall, our population was much younger, with a median age of 15.5 months vs. 1–7 years in most other groups. 4,9,30,31 The smaller vessel sizes in our younger cohort might contribute to an increased thrombotic risk. 4,5 Other pediatric cohorts included patients with similar transplant indications, but none we found included patients undergoing multivisceral transplant.…”

“…Our 30-day survival rate was 95% and 1-year survival rate was 93%, which is in line with survival data from other studies. 4,11,12,30,31 Of the four deaths within 30 days of transplant, three were due to vascular thrombosis.…”

Postoperative complications in cirrhotic pediatric deceased donor liver transplantation: Focus on transfusion therapy

“…Several studies have shown a negative impact of transfusion therapy on patient and graft survival in adult populations . In a previous study, we showed that RBC and FFP transfusions are independent risk factors for patient and graft survival after PLTx …”

Plasma in the PICU: why and when should we transfuse?

“…In children undergoing liver transplantation, plasma transfusions are associated with increased 1-year mortality [50]. Therefore, it seems reasonable to transfuse plasma only in the setting of a severe bleeding with abnormal coagulation tests.…”