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LIVER TRANSPLANTS: SHOULD WE TRANSFUSE?

Anesthesiology Department, Hôpital Saint-Luc du CHUM, 1058, Saint-Denis street, Montreal, Quebec H2X 3J4

INTRODUCTION

Liver transplant surgery may be associated with important blood loss that requires blood product transfusions ¹.

Transfusions contribute to morbidity and mortality ^2–3. Improvements in surgical and anesthesiology technique have led to a reduction in the number of transfused blood products 2. The purpose of this study was to identify the factors that would lead to a blood product transfusion amongst different anesthesiologists and to find their threshold for packed cells transfusion. Finally, we analysed the transfusion rate variability during liver transplant.

METHODS

We retrospectively studied 206 consecutive liver transplants. For each, transfused blood products were identified and quantified. The transplants were divided into 2 groups: high volume transfusions (> 4 units of packed cells) and low volume transfusions ( 4 units of packed cells). Univariate and multivariate analyses addressed 18 variables.

RESULTS

The average number of blood transfusions was 2,8 / patient, with a median at 2,0. 66 patients (32 %) received no packed cells and 40 patients (19,4 %) received no blood product. One-year survival was 79,9 %. Plasma or packed cell transfusions were associated with a significant decrease in one-year survival.

Subgroup Number One-year survival No blood product 40 93,8 % P = ,05 Plasma only 26 73,9 % 1 to 4 units packed cells 97 87,0 % P = ,005 > 4 units packed cells 43 61,1 %

DISCUSSION

Pre-surgery INR and platelet count, as well as the duration of surgery were associated with the number of transfused packed cells.

For liver transplants, an average of 2,8 units of packed cells was transfused per patient. This transfusion rate is appreciably lower than reported in current literature. Certain surgeons and anesthesiologists regularly perform transfusion-free liver transplant

Overall survival decreased according to the number of transfused packed cell and plasma units. It was not associated with pre-surgery INR increases.

Our results suggest but do not prove causality between rates of transfused packed cell and/or plasma units, and decreased survival.

REFERENCES

1 Anesth Analg. 1994; 78: 120–133.[Free Full Text]

2 Arch Surg. 1999; 134: 25–29.[Abstract/Free Full Text]

3 N Engl J Med. 1999; 340: 438–447.[Free Full Text]

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This Article Full Text (PDF) Submit a scholarly reply Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services Similar articles in this journal Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Massicotte, L. Search for Related Content PubMed Articles by Massicotte, L.