Balanced Blood Product Transfusion during Adult Liver Transplantation

Abstract

Background: Orthotopic liver transplant (LT) is often associated with massive blood loss and significant transfusion requirements. Recent recommendations for resuscitation strategy in massive bleeding include the transfusion of balanced blood products, fresh frozen plasma (FFP), platelets, packed red blood cells (PRBC), and restricted use of crystalloids. Objectives: To evaluate whether the intraoperative transfusion ratio of fresh frozen plasma to packed red blood cell units (FFP: PRBC ≤1:1 versus >1:1) plays a positive role in reducing PRBC transfusion in LT. Methods: This is a retrospective study of 84 liver transplant recipients who received at least one PRBC unit during the surgery. The patients were grouped into those who received intraoperative FFP: PRBC ratio ≤1:1 (low ratio) versus the ratio>1:1 (high ratio). Selected perioperative variables were compared between the two groups. Results: Patients in the low-ratio versus high-ratio group had lower intraoperative requirements for PRBC (P<0.001). Importantly, in the high-ratio group, the mean postoperative PRBC transfused units were 1.76 times that of the low-ratio group (incidence rate ratio [IRR], 1.76; 95% CI=1.07-2.90). There was a significant difference between the two groups in preoperative body mass index (P=0.047), hemoglobin (P=0.005), and surgical time (P=0.071); moreover, all the variables were higher in the high-ratio group. After adjusting the variables, postoperative PRBC consumption in the low-ratio group was 43% less than that in the high-ratio group (P=0.007). Conclusion: The intraoperative low-ratio transfusion was associated with a reduced need for total PRBC transfusion in LT.