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Prediction of intraoperative transfusion requirements during orthotopic liver transplantation and the influence on postoperative patient survival.

Abstract：

BACKGROUND:Predicting blood product transfusion requirements during orthotopic liver transplantation (OLT) remains difficult. Our primary aim in this study was to determine which patient variables best predict recipient risk for large blood transfusion requirements during OLT. The secondary aim was to determine whether the amount of blood products transfused during OLT impacted patient survival. METHODS:Eight hundred four primary adult OLTs performed during a 9-year period were retrospectively analyzed, and predictive models were developed for blood product usage, usage >20 and usage >30 units of red blood cells (RBCs) plus cell salvage (CS). For survival analysis, potential predictors included all blood products administered during OLT. RESULTS:For analyses of RBC + CS usage, we used several statistical techniques: regression analysis, logistic regression, and classification and regression tree analysis. Several preoperative factors were highly statistically significant predictors of intraoperative blood product usage in each of the analyses, namely lower platelet count and higher Model for End-Stage Liver Disease Score or one or more of its components (creatinine, total bilirubin, international normalized ratio). Despite these highly significant associations, the models were unable to predict reliably that patients might require the largest amount of blood products during OLT. For example, the classification and regression tree analyses were able to predict only 32% and 11% of patients requiring >20 and >30 units of RBC + CS, respectively. Survival analysis demonstrated poorer survival among patients receiving larger amounts of RBC + CS during OLT. CONCLUSION:Prediction of intraoperative blood product requirements based on preoperatively available variables is unreliable; however, there is a strong measurable association between transfusion and postoperative mortality.

journal_name

Anesth Analg

journal_title

Anesthesia and analgesia

authors

Cywinski JB,Alster JM,Miller C,Vogt DP,Parker BM

doi

10.1213/ANE.0b013e3182a76f19

subject

Has Abstract

pub_date

2014-02-01 00:00:00

pages

428-37

issue

eissn

0003-2999

issn

1526-7598

pii

00000539-201402000-00025

journal_volume

118

pub_type

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Prediction of intraoperative transfusion requirements during orthotopic liver transplantation and the influence on postoperative patient survival.