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Intraoperative blood losses and transfusion requirements during adult liver transplantation remain difficult to predict

[Les pertes sanguines peropératoires et les besoins transfusionnels restent toujours difficiles à prédire pendant la greffe du foie]

A. Steib, MD^*, G. Freys, MD^*, C. Lehmann, MD^*, C. Meyer, MD and G. Mahoudeau, MD^*

^* From the Departments of Anaesthesia, and
Transplantation, Hôpitaux Universitaires, Strasbourg, France.

Dr. Annick Steib, Departement of Anaesthesia, 1 Place de l'Hôpital, BP N 426, 67091 Strasbourg Cedex, France. Phone: 03 88 11 54 10; Fax: 03 88 11 67 60; E-mail: Annick.Steib{at}chru-strasbourg.fr

Purpose: To identify preoperative factors associated with high blood losses during liver transplantation for chronic end-stage liver disease.

Methods: Four hundred and ten consecutive patients were included in this retrospective study. Blood losses were calculated, based on transfusion requirements. The population was divided into two groups: the upper quartile was defined as the high blood loss (HBL) group and the lower three quartiles as the low blood loss group. Fourteen preoperative variables were collected. Qualitative variables consisted of the type of hepatopathy, Child-Pugh's classification, sex, the surgical team's experience, previous abdominal surgery and portal hypertension. Quantitative variables were age, hemoglobin concentration Hb, platelet count, prothrombin time, activated partial thromboplastin time, fibrinogen concentration, fibrin degradation products (FDP) and euglobulin lysis time. Univariate analysis and stepwise multivariate analysis were conducted.

Results: Patients in the HBL group required 12 units of red blood cell or more to maintain a Hb 100g•L^-1. HBL was associated with severe liver disease, previous abdominal surgery, use of a venovenous bypass and little surgical experience in orthotopic liver transplantation (OLT). In the HBL group several hemostatic parameters were more disturbed before surgery. The multivariate analysis disclosed three independent variables associated with HBL: Hb and FDP concentrations and previous upper abdominal surgery. When combined, these resulted in a high specificity (98%) but low sensitivity to predict blood loss.

Conclusion: Despite our efforts we were unable to identify predictive risk factors of bleeding during OLT even in a homogeneous population. Centres should evaluate their practice individually in an attempt to identify patients at high risk of being transfused.

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