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Multicenter Study on Perioperative Transfusions Requirements in Liver Transplantation

Multicenter Study on Perioperative Transfusions Requirements in Liver Transplantation

Anesthesiology Abstracts of Scientific Papers Annual Meeting (2000): Abstract No 202

Introduction: The aim of this multicenter prospective study was to evaluate blood transfusion requirements in orthotopic liver transplantation (OLT) and to determine factors linked to an increase in red-cell transfusions. Material and methods: After Institutional Approval, we enrolled all consecutive patients over 18 yr of age, who underwent OLT from 1/99 to 12/99 in 8 Universitary Hospitals in France (City of Bordeaux, Clichy, Lille, Lyon, Nice, Paris, Rennes and Strasbourg). Demographic data, surgical and anesthetic techniques, patient outcome and transfusion requirements of red-cell, fresh frozen plasma (FFP) and platelets were recorded prospectively untill the 8th postoperative day. Factor linked to an increase in red-cell transfusions were determined by univariate and multivariate analysis. Results are given as mean+-SD. P<0.05 is considered significant. Results: 303 patients were included (M/F: 76/34%, age: 50+-8 yr). 85% of the patients had a liver cirrhosis, 27% a carcinoma, 4% a fulminant hepatitis. Hemoglobin level was <10.0 g/dL in 30% of patients, prothrombine time (PTT) was <40% in 20%, platelets count was <50.109/L in 18%. The following techniques were used : split : 1.4%; porto-caval anastomosis: 49%; extracorporeal circulation: 4%; intraoperative blood recuperation: 42%. Mortality rate was 4% on postoperative day 8. Red-cell transfusion was performed in 88% of the patients (red-cell units (mean (50th-95th percentile): 9 (6-21)). FFP was administered to 74% of the patients (FFP units: 17 (7-41)). 61% of the patients received platelets (platelets units: 61 (7-48)). Independent factors (multivariate analysis) associated to an increase in red-cell transfusion are given in Table I. Discussion: Transfusion requirements, and the related costs of blood products, during OLT are very high, as only 12% of the patients received no transfusion at all. Significant variability between Institutions were observed. Risk factors of increased transfusion requirements may be identified preoperatively.

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