Blood transfusion requirement during liver transplantation is an important risk factor for mortality. J Am Coll Surg 2013 May;216(5):902-7
Date
03/13/2013Pubmed ID
23478547DOI
10.1016/j.jamcollsurg.2012.12.047Scopus ID
2-s2.0-84876677984 (requires institutional sign-in at Scopus site) 140 CitationsAbstract
BACKGROUND: Blood loss during liver transplantation is not incorporated into the dominant models for post-transplant survival. Our objective was to investigate blood transfusion requirement as a risk factor for mortality after liver transplantation, and to further analyze risk factors for intraoperative blood transfusion requirement and hepatectomy time.
STUDY DESIGN: We conducted a retrospective analysis of 233 consecutive liver transplant recipients over a span of 3 years by a single experienced surgeon. Mean follow-up was 2.5 years. Independent risk factors for patient survival after liver transplantation were identified using Cox proportion hazard regression. Independent risk factors for intraoperative blood transfusion requirement and hepatectomy time were identified using logistic regression.
RESULTS: Two factors were identified as significant predictors in multivariate analysis for survival after liver transplantation: hepatocellular carcinoma (hazard ratio [HR] 1.9, 95% CI 1.1 to 3.2) and intraoperative blood transfusion requirement per unit (HR 1.01, 95% CI 1.0 to 1.02). Threshold analysis revealed that intraoperative blood transfusion volume ≥28 units or 85(th) percentile (HR 2.5, 95% CI 1.3 to 4.7) was a significant risk factor for patient survival. Four covariates were identified as significant risk factors for intraoperative blood requirement: warm ischemia time (odds ratio [OR] 1.12, 95% CI 1.06 to 1.18), bilirubin (OR 1.04, 95% CI 1.02 to 1.08), previous surgery (OR 1.7, 95% CI 1.02 to 2.9), and hepatectomy time (OR 1.01, 95% CI 1.00 to 1.02). The only risk factor for prolonged hepatectomy time was previous major abdominal surgery (OR 4.0, 95% CI 1.7 to 9.5).
CONCLUSIONS: Intraoperative blood transfusion requirement is an important risk factor for mortality after liver transplantation. The strongest risk factors for intraoperative blood transfusion requirement are warm ischemia time and bilirubin levels. Intraoperative blood loss and its risk factors should be incorporated into models to predict survival after liver transplantation.
Author List
Rana A, Petrowsky H, Hong JC, Agopian VG, Kaldas FM, Farmer D, Yersiz H, Hiatt JR, Busuttil RWMESH terms used to index this publication - Major topics in bold
AbdomenAdult
Analysis of Variance
Bilirubin
Blood Loss, Surgical
Blood Transfusion
Erythrocyte Transfusion
Female
Hepatectomy
Humans
Liver Transplantation
Logistic Models
Male
Middle Aged
Odds Ratio
Operative Time
Proportional Hazards Models
Retrospective Studies
Risk Assessment
Risk Factors
Surgical Procedures, Operative
Transfusion Reaction
Treatment Outcome
Warm Ischemia
