Ascites, but Not Hyponatremia, Is Associated With High Intraoperative Transfusion and Vasopressor Requirements During Liver Transplantation

Abstract

Background We previously demonstrated that patients with high MELD scores required significantly higher volumes of blood transfusion and vasopressor usage during orthotopic liver transplantation (OLT) compared with patients with low MELD scores. Now we investigated whether hyponatremia or ascites were associated with increased transfusion and vasopressor requirements during OLT. Methods Medical records of 192 OLT patients between January 1, 2004, and May 5, 2005, were retrospectively reviewed. Intraoperative transfusion of red blood cells (RBC) or fresh frozen plasma (FFP) and administration of vasopressors were compared. Results As expected, patients with high (>30) MELD scores were associated with higher requirements for intraoperative transfusion and vasopressors than those with low (≤30) MELD scores. Patients with or without hyponatremia (Na + > or ≤130) had similar requirements for transfusion and vasopressors. Patients with ascites had significantly higher requirements for both transfusion and vasopressors compared with those without (16.6 ± 9.6 versus 11.8 ± 9.0 for RBC; 22.0 ± 11.0 versus 16.1 ± 11.8 for FFP; and 60.2% versus 37.5% for vasopressors, P = .001 to .002). Patients with high (>30) MELD plus ascites scores (MELD+A, 4.5 points added to MELD if ascites was present) had higher requirements for transfusion and vasopressors compared with patients with low (≤30) MELD+A scores (16.1 ± 9.9 versus 11.4 ± 8.6 for RBC; 21.7 ± 12.7 versus 15.2 ± 9.6; and 63.4% versus 28.2% for vasopressors, P = .001 to <.001). Conclusion Although hyponatremia and ascites are indicators for liver disease severity, ascites, but not hyponatremia, is associated with increased intraoperative transfusion and vasopressor requirements during OLT.