Predictors of intraoperative massive transfusion in orthotopic liver transplantation

Background Although transfusion management has improved during the last decade, orthotopic liver transplantation (OLT) has been associated with considerable blood transfusion requirements which poses some challenges in securing blood bank inventories. Defining the predictors of massive blood transfu...

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Published in:	Transfusion (Philadelphia, Pa.) Vol. 64; no. 1; pp. 68 - 76
Main Authors:	Alhamar, Mohamed, Uzuni, Ajna, Mehrotra, Harshita, Elbashir, Jaber, Galusca, Dragos, Nagai, Shunji, Yoshida, Atsushi, Abouljoud, Marwan S., Otrock, Zaher K.
Format:	Journal Article
Language:	English
Published:	Hoboken, USA John Wiley & Sons, Inc 01-01-2024 Wiley Subscription Services, Inc
Subjects:	Abdominal surgery Adolescent Adult Aged Blood banks Blood Loss, Surgical Blood Transfusion Blood transfusions Correlation coefficient Correlation coefficients Demographic variables End Stage Liver Disease - surgery Erythrocytes Female Hemoglobin Hemoglobins - analysis Humans intraoperative Ischemia Liver Liver diseases liver transplant Liver Transplantation Liver transplants Male massive transfusion Middle Aged Multivariate analysis Platelets predictors Retrospective Studies Severity of Illness Index Statistical analysis Surgery Transfusion Transplantation Young Adult intraoperative predictors liver transplant massive transfusion
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Summary:	Background Although transfusion management has improved during the last decade, orthotopic liver transplantation (OLT) has been associated with considerable blood transfusion requirements which poses some challenges in securing blood bank inventories. Defining the predictors of massive blood transfusion before surgery will allow the blood bank to better manage patients' needs without delays. We evaluated the predictors of intraoperative massive transfusion in OLT. Study Design and Methods Data were collected on patients who underwent OLT between 2007 and 2017. Repeat OLTs were excluded. Analyzed variables included recipients' demographic and pretransplant laboratory variables, donors' data, and intraoperative variables. Massive transfusion was defined as intraoperative transfusion of ≥10 units of packed red blood cells (RBCs). Statistical analysis was performed using SPSS version 17.0. Results The study included 970 OLT patients. The median age of patients was 57 (range: 16–74) years; 609 (62.7%) were male. RBCs, thawed plasma, and platelets were transfused intraoperatively to 782 (80.6%) patients, 831 (85.7%) patients, and 422 (43.5%) patients, respectively. Massive transfusion was documented in 119 (12.3%) patients. In multivariate analysis, previous right abdominal surgery, the recipient's hemoglobin, Model for End Stage Liver Disease (MELD) score, cold ischemia time, warm ischemia time, and operation time were predictive of massive transfusion. There was a direct significant correlation between the number of RBC units transfused and plasma (Pearson correlation coefficient r = .794) and platelets (r = .65). Discussion Previous abdominal surgery, the recipient's hemoglobin, MELD score, cold ischemia time, warm ischemia time, and operation time were predictive of intraoperative massive transfusion in OLT.
Bibliography:	This work was presented, in part, at the AABB Annual Meeting, October 3–5, 2020. Mohamed Alhamar and Ajna Uzuni contributed equally to this study and manuscript. ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	0041-1132 1537-2995
DOI:	10.1111/trf.17600