Risk Factors for Transfusion after Orthotopic Liver Transplantation

Ana Paula Hitomi Yokoyama; José Mauro Kutner; Araci Massami Sakashita; Cristiane Yoshie Nakazawa; Tatiana Almeida Omura de Paula; Raffael Perreira Cezar Zamper; Pamella Tung Pedroso; Marcio Dias de Almeida; Sergio Paiva Meira Filho; Fernanda Andrade Orsi

doi:10.1159/000499120

Risk Factors for Transfusion after Orthotopic Liver Transplantation

Transfus Med Hemother. 2019 Dec;46(6):431-439. doi: 10.1159/000499120. Epub 2019 Apr 3.

Affiliations

¹ Hemotherapy and Cell Therapy Department, Hospital Israelita Albert Einstein, São Paulo, Brazil.
² Hemotherapy Department, Hospital Municipal Vila Santa Catarina, São Paulo, Brazil.
³ Anesthesiology Department, Hospital Israelita Albert Einstein, São Paulo, Brazil.
⁴ Liver Transplantation Unit, Hospital Israelita Albert Einstein, São Paulo, Brazil.
⁵ Department of Clinical Pathology, School of Medical Sciences, University of Campinas (UNICAMP), Campinas, Brazil.

Abstract

Background: Transfusion of blood products during orthotopic liver transplantation (OLT) is associated with increased morbidity and mortality. Although risk factors associated with intraoperative transfusion requirements have been widely assessed, published data on the prediction of postoperative transfusion requirements are sparse.

Objectives: The aim of this study was to evaluate risk factors for postoperative allogeneic transfusion requirements in OLT.

Methods: Clinical characteristics and intraoperative parameters of 645 consecutive adult patients undergoing OLT were retrospectively reviewed. Multivariate logistic regression was used to determine the main determinants for postoperative transfusion requirements.

Results: Determinants of postoperative transfusion requirements of any blood product in the postoperative period were the number of blood products transfused in the intraoperative period (OR 1.17, 95% CI 1.08-1.28), warm ischemia time (OR 1.05, 95% CI 1.02-1.08), MELD score (OR 1.05, 95% CI 1.01-1.08) and hepatocellular carcinoma (OR 0.45, 95% CI 0.28-0.72). A dose-dependent effect between the number of units transfused in the intraoperative period and transfusion requirements in the postoperative period was also observed. The relative risk of postoperative allogeneic transfusion of any blood component was 5.9 (95% CI 3.4-10.4) for patients who received 1-2 units in the intraoperative period, 7.3 (95% CI 3.6-14.7) for those who received 3-5 units in the intraoperative period, and 11.1 (95% CI 4.7-26.4) for those who received 6 or more units, when compared to no intraoperative blood transfusion.

Conclusion: Our study demonstrated an association between intraoperative transfusion and warm ischemia time with postoperative transfusion requirements. The identification of risk factors for transfusion in the postoperative period may improve management of these patients by increasing awareness to bleeding complications in this high-risk population and by expanding hemostasis monitoring to the postoperative period.

Keywords: MELD score; Orthotopic liver transplantation; Risk factors; Transfusion.