Intraoperative blood loss and blood transfusion requirement among liver transplant recipients: A national single-center experience 2020
Mohd Faeiz Yusop1, Norlida Mohamad Tahir1, Sharifah Mai Sarah Syed Azim1, Ameera Ashyila Kamaruzaman1, Nur Raihan Mohd Hata1, Arvend Kugaan1, Mohd Fairuz Osman1, Tengku Norita Tengku Yazid1, Suryati Mokhtar2, Haniza Omar3, Ahmad Suhaimi Amir4
1 Department of Pathology, Hospital Selayang, Selangor, Ministry of Health, Malaysia
2 Department of Hepatobiliary, Hospital Selayang, Selangor, Ministry of Health, Malaysia
3 Department of Hepatology, Hospital Selayang, Selangor, Ministry of Health, Malaysia
4 Department of Anaesthesiology and Intensive Care Unit, Hospital Selayang, Selangor, Ministry of Health, Malaysia
Mohd Faeiz Yusop,
Department of Pathology, Hospital Selayang, Ministry of Health
Source of Support: None, Conflict of Interest: None
BACKGROUND: Liver transplantation (LT) is a complicated surgical procedure with high risk for massive intraoperative blood loss due to pre-existing coagulopathy, portosystemic shunts with collateral circulations, and splenomegaly. The transfusion service will direct most of their resources toward LT programs with great impact on cost. The purpose of this study was to evaluate single center transfusion strategies and to identify the risk factors associated with the intraoperative blood loss and blood transfusion.
METHODS: The study includes 18 patients who underwent LT at Hospital Selayang between January 2020 and December 2020. Retrospective analysis of data included preoperative assessment of coagulopathy, intraoperative blood loss, and blood component transfusion
RESULTS: The mean age in the study group was 36.4 ± 12.68 years. The mean intraoperative blood loss was 4450 ± 1646 ml requiring 4.17 ± 3.3 packed red blood cell (PRBC) units, 7.56 ± 5.5 platelet units, and 9.50 ± 6.0 fresh-frozen plasma units. The independent risk factor for high blood loss (HBL) group was lower preoperative platelet count and it is statistically significant (P = 0.024). The HBL group is associated with higher usage of PRBC (P = 0.024) and platelet units (P = 0.031) and it is statistically significant. The length of stay (LOS) in intensive care unit (ICU) averaging 8.6 ± 4.95 days, and there is no significant differences comparing the HBL and LBL group (P = 0.552). The mortality <90 days for all recipients was 22.2%.
CONCLUSION: The preoperative platelet count for is the most important factor associated with HBL in LT procedure. The usage of PRBC and platelet units was statistically higher in the HBL group. Comparing HBL and LBL patients, there is no difference in terms of the LOS in ICU postoperatively. A larger sample size would be needed in view of relatively small sample size.