Analysis of Liver Transplant without Blood Transfusion in Adult Patients

Abstract

Introduction: Liver transplantation (LT) is closely associated with blood transfusion practices since the first transplants. Requirement of blood has been reduced by advance and refinements in patient selection, transfusion methods, and surgical technique. LT without any blood product became real clinical practice in patient with stable preoperative condition. The aim of this study was to analyze the pre-operative, intra-operative, post-operative factors associated with LT without intraoperative red blood cell (RBC) transfusion. Methods: Four hundreds forty four adult patients were selected from our database due to the less than 5 units of RBC transfusion. Out of 444, 51 patients were selected as study group due to no RBC transfusion and 389 patients were selected as control group due to the 1-5 units of RBC transfusion during LT surgery. Coagulations were monitored intraoperatively and corrected if clinically indicated. Aprotinin was not used. Auto transfusion of blood salvaged was used routinely following our protocol. Independent factors were analyzed to find a link with no RBC transfusion. Survival curve was generated by Kaplan Meier methods and compared with log rank test. Results: Factors of study group vs. control group were as follows: MELD score was 20 vs. 20. Calculated MELD score was 12 vs. 12. Cold ischemic time was 429 vs. 425 min. Warm ischemic time was 37.0 vs. 37.1 min. Donor age was 41 vs. 39 yrs. Use of piggyback technique (PB) was 94% (n=48) vs. 92% (n=363). Use of Conventional cava reconstruction was 6% (n=3) vs. 8% (n=30). There were no statistically significant differences in demographic factors including donor age, recipient age, primary liver diagnosis, MELD score, CIT, WIT, INR, Cr, bilirubin, and amounts of auto-transfusion, cava reconstruction methods between the groups. Amount of fresh frozen plasma is significantly less in study group (P< 0.05). One, 3, 5 years' patient and graft survival were 92%, 88% 79% and 92%, 88%, 79% in study group and 89%, 82%, 76% and 84%, 78%, 71% in control group respectively. There was no statistical difference in patient and graft survival between the groups. Conclusion: Preoperative factor have limited predictive power for no intra-operative RBC transfusion in patient with stable condition. No transfusion could be achieved by LT. LT without transfusion did not show survival benefit. Surgical technique and auto transfusion of blood salvaged may play roles to decrease the intra-operative RBC requirements.[Figure 1]