PB1065 - Risk factors associated with blood transfusion in liver transplantation

Background: Although clear improvements have been made in liver transplantation (LT) techniques over time, the need for infusion of blood components or products and red blood cells (RBCs) remains high, influencing LT outcomes

Aims: To explore preoperative and operative risk factors for red blood cell (RBC) transfusion requirements during liver transplantation (LT) and up to 24 h afterwards.

Methods: We evaluated the associations between risk factors and units of RBC transfused in 176 LT patients using a log-binomial regression model. Relative risk was adjusted for age, sex, and the Model for End-Stage Liver Disease score (MELD) (adjustment 1) and baseline hemoglobin concentration (adjustment 2).

Results: Forty-six patients (26.14%) did not receive transfusion. Grafts from cardiac-death donors were used in 32.61% and 31.54% of non-transfused and transfused patients, respectively. A portacaval shunt was used in 32.40% of non-transfused patients and 38.46% of transfused patients. MELD and hemoglobin concentrations determined RBC requirements. For each unit of increase in the MELD score, 2% more RBC units were transfused, and non-transfusion was 0.83-fold less likely. For each 10-g/L higher hemoglobin concentration at baseline, 16% less RBC transfused, and non-transfusion was 1.95-fold more likely. Ascites was associated with 26% more RBC transfusions. With an increase of 2 mm from the baseline in the A10FIBTEM measurement of maximum clot firmness, non-transfusion was 1.14-fold more likely. A 10-minute longer cold ischemia time was associated with 1% more RBC units transfused, the need for tranexamic acid with 19% more RBC units, and the presence of post-reperfusion syndrome with 45% more RBC units. Each 60 min surgical time longer than the mean was associated with 1% more RBC units required.

Conclusion(s): Preoperative correction of anemia should be included in the preparation for LT. We propose clinical trial testing of a triple intervention to prevent severe hypotension, fibrinolysis, and hypofibrinogenemia during graft reperfusion.