LIVER TRANSPLANTATION(3)

liver411

December 2003 . Volume 9 . Number 12

Original Articles

Intraoperative red blood cell transfusion in liver transplantation:
Influence on patient outcome, prediction of requirements, and measures to
reduce them

Emilio Ramos ,Antonia Dalmau ,Antonio Sabate
Carmen Lama ,Laura Llado ,Juan Figueras ,Eduardo Jaurrieta

Abstract
Objectives of this study are to quantify the need for blood transfusion
during liver transplantation (LT) and confirm the importance of
intraoperative blood transfusion as an independent prognostic factor for
postoperative outcome. Furthermore, we try to detect useful variables for
the preoperative identification of patients likely to require transfusion of
packed red blood cell units (PRCUs) and identify measures to reduce
transfusion needs. Data were collected prospectively between September 1998
and November 2000. One hundred twenty-two LTs were included in the study.
Forty-two patients (34%) did not require transfusion of PRCUs. In
multivariate analysis, transfusion of more than three PRCUs was found to be
the only significant variable associated with prolonged hospital stay. In
addition, excluding perioperative deaths, PRCU transfusion, using a cutoff
value of six units, was the only variable to reach statistical significance
(P = .008; risk ratio, 4.93; 95% confidence interval, 15 to 15.9) to predict
survival in a multivariate analysis that also included Child's class and
United Network for Organ Sharing (UNOS) classification. Moreover, only
preoperative hemoglobin (Hb) level was found to significantly predict the
need for transfusion of one or more PCRUs. Finally, only UNOS classification
and placement of an intraoperative portacaval shunt were found to be
statistically significant to predict the need to transfuse more than six
PRCUs. We found the requirement of even a moderate number of blood
transfusions is associated with longer hospital stay, and transfusion of
more than six PRCUs is associated with diminished survival. Preoperative
normalization of Hb levels and placement of an intraoperative portacaval
shunt can diminish the number of blood transfusions during LT. (Liver
Transpl 2003;9:1320-1327.)

   Publishing and Reprint Information
From the Liver Transplantation Unit, Hospital Universitario de Bellvitge,
Barcelona, Spain.

Address reprint requests to Emilio Ramos Rubio, MD, Unidad de Trasplante
Hepático, Hospital Universitario de Bellvitge, Av Feixa Llarga s/n,
L'Hospitalet 08907, Barcelona, Spain. Telephone: 34-93-260-7940; FAX:
34-93-260-7603; E-mail: [email protected]

Copyright © 2003 by the American Association for the Study of Liver Diseases
1527-6465/03/0912-0012$30.00/0
doi:10.1016/jlts.2003.50204