Trends in transfusion practice over 20 years in paediatric liver transplant programme

Abstract

Background We investigated changes to transfusion practices over time in paediatric liver transplant centre and evaluated the effect of transfusion practice to mortality.Methods A pilot retrospective study included two cohorts each with 101 sequential paediatric LT recipients: an Early group (1994)(1995)(1996)(1997)(1998) and a Recent group (2009)(2010)(2011)(2012)(2013). Demographic characteristics and data on the intraoperative transfusion of red blood cells (RBC), fresh-frozen plasma (FFP), platelets and cryoprecipitate were collected. Postoperative laboratory results were also obtained, together with donor and data regarding 1-and 5-year survival. Appropriate intergroup comparisons, univariate and multivariate analysis were made and P ≤ 0Á05 was considered statistically significant.Results There were no significant group differences in demographic data (except patient height). Despite the fact that median total blood loss did not differ between groups (111 ml/kg in both groups), the Early group had greater levels of intraoperative RBC transfusion (75 vs. 59 ml/kg, respectively, P = 0Á04) and less use of FFP (53 vs. 62 ml/kg, respectively, P = 0Á01). Overall we noted a lower 1and 5-year survival in the Early group (88Á2% vs. 96%, P = 0Á04 and 82Á4% vs. 89Á1%, P = 0Á01, respectively). Univariate, but not multivariate regression analyses demonstrated that higher PELD score, RBC and FFP transfusion, and inclusion in the Early group were contributing factors to 1-year higher mortality.Conclusions This retrospective analysis of blood loss and replacement in paediatric LT patients demonstrates that the majority of our patients suffer major haemorrhage and require large-volume RBC and FFP replacements. In our pilot study, large volume of RBC and FFP replacement did not contribute to mortality. Paediatric LT involves a number of multidisciplinary teams. Thus, all care-related factors and combinations thereof that may contribute to outcome and should be evaluated in the future.

A Case of Difficult Arterial Cannulation: Is Intra-Arterial Blood Pressure Monitoring an Absolute Requirement for Paediatric Liver Transplantation?

“…At our centre, both adult and paediatric LT services are provided by the same anaesthetic team, led by eight dedicated LT consultant anaesthetists. At King’s, we know that we have relatively large volume transfusion requirements and, traditionally, our consultant appointments have reflected this issue, favouring those with expertise in haemodynamic management rather than those with extensive formal paediatric experience [ 4 ]. We maintain that this expertise in haemodynamic management remains vital given our large transfusion requirements, and that it is probably of greater importance than paediatric skills per se.…”