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BLOOD PRODUCT USE DURING HEPATIC TRANSPLANT.

¹ Departments of Anaesthesia &
² Surgery, Royal Victoria Hospital & McGill University, 687 Pine Ave. W., Montreal, Quebec, H3A 1A1.

INTRODUCTION

Liver transplantation is associated with considerable blood product requirement^1,2, yet bloodless transplantation has been achieved in Jehovah's Witness patients³. The patient profile associated with bloodless liver transplantation has not been validated⁴. In this study of intra-operative blood product use, patient characteristics were compared in those who did not (Group 1) and did (Group 2) require blood products.

METHODS

We reviewed 218 consecutive first-time liver transplants (1995-2000). Patients were anesthetized using a standardized protocol. Temperature was maintained by administration of warmed fluids and air. All patients received aprotinin (500,000-2,000,000 U bolus post-induction followed by 500,000U.hr^-1. Blood sampling was kept to a minimum, and scavenged blood was returned to the patient. Transfusion triggers for PRBC's included Hct < 0.25 or sudden catastrophic blood loss. Although platelet count, fibrinogen level, PT and PTT were periodically measured, trigger for transfusion of platelets, cryoprecipitate and FFP was based on the clinical impression of excessive oozing and lack of clots.

RESULTS

35 patients (Group 1, 16%) received no blood products. 183 patients (Group 2, 84%) received PRBC,s (3.9±2.8 [SD] U), FFP (5.6±4.1 U), platelets (4.8±7.6 U) or cryoprecipitate (3.3±5.6 U). Groups 1 & 2 could not be differentiated on the basis of age (53.5±14.6; 55.7±11.1 yrs), gender (M/F: 68%/31%; 65%/35%), BMI (27.5±5.7; 26.4 ±4.9 kg.m^-2) and etiology of liver failure. Group 2 had lower hemoglobin (120± 17; 105±19g.L^-1, NS) and platelets (151±67; 100±63 x10⁹.L^-1, NS), and higher PT (16.6±3.2; 17.9±8.5 sec, NS), PTT (40.2±15.7; 53.9±22.5 sec, NS) and Child's-Pugh score (7.6±2.4; 9.8±2.4, p< 0.0001). Using pre-operative cut-off values of Hct 0.35, platelets 80x10⁹.L^-1, PT 15 sec, PTT 45 sec, and Child's-Pugh score 7, there was a correct prediction that products would be required in 169/183 (92%) patients and that they would not be necessary in 15/33 patients (45%).

DISCUSSION

Liver transplant may be associated with less blood product transfusion than previously reported^1,2. A subset of patients may be considered for bloodless surgery.

REFERENCES

1 Blood Coagulation & Fibrinolysis 2000; 11: S87–93.

2 Can J Anesth 2001; 48: 1075–79.[Abstract/Free Full Text]

3 Can J Anesth 200; 47: 642-46.[Abstract/Free Full Text]

4 Arch Surg 1994; 129: 528–32.[Abstract]

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