Eliminating international normalized ratio threshold for transfusion in pediatric patients with acute liver failure.

Abstract:

INTRODUCTION:Transfusion protocols are not well-studied for pediatric patients with acute liver failure (ALF). This study evaluates the utility of an international normalized ratio (INR)-based transfusion threshold for these patients. METHODS:Forty-four ALF pediatric patients from 2009 to 2018 were reviewed and divided into two groups: (a) a threshold group including patients between 2009 and 2015 who were transfused for an INR above 3.0, per institutional policy (n = 30), and (b) a post-threshold group including patients after 2015 through 2018 who were transfused based on clinical judgment (n = 14). Preoperative INRs, preoperative transfusions, intraoperative transfusions, early reoperation, renal function, graft function and deaths were compared. RESULTS:Liver failure severity was similar between threshold and post-threshold groups. Threshold patients had a lower average INR prior to transplantation, 2.8 (range 1.8-3.8) vs 4.4 (range 2.1-9.0), respectively (P = .01). Twenty-six threshold patients (87%) received preoperative FFP compared with seven post-threshold patients (50%, P = .0088). Two threshold patients (7%) received preoperative cryoprecipitate compared with five post-threshold patients (36%, P = .014). The incidence of pre-transplant bleeding, operative transfusions, and 1-year patient and graft survival did not differ significantly. CONCLUSION:Clinical judgment vs an INR-based threshold for transfusions did not increase perioperative complications in children with ALF.

journal_name

Clin Transplant

journal_title

Clinical transplantation

authors

Lee A,Mendoza J,Brubaker AL,Stoltz DJ,McKenzie R,Bonham CA,Esquivel CO,Gallo AE

doi

10.1111/ctr.13819

subject

Has Abstract

pub_date

2020-04-01 00:00:00

pages

e13819

issue

4

eissn

0902-0063

issn

1399-0012

journal_volume

34

pub_type

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