Effect of Blood Transfusion on Liver Transplant Outcome in Adult Patients

Abstract

Introduction: Requirement of blood transfusions during liver transplantation (LT) has been reduced by refinements in patient selection, transfusion methods, and surgical technique. LT with limited volume of blood product is the current clinical practice. The aim of this study was to analyze the effect of intra-operative red blood cell (RBC) transfusion volume on liver transplant outcome in adult patients. Methods: Two thousands two hundreds twenty eight adult patients were selected from our database. Out of 2228, 1960 patients were included for this study. Fifty one patients were selected as group 1 (G1) due to no RBC transfusion, 1557 patients as group 2 (G2) due to the 1-20 units of RBC transfusion, and 352 patients as group 3 (G3) due to more than 20 units of RBC transfusion during LT surgery. Aprotinin was not used. Auto transfusion of blood salvaged was used routinely. Independent factors were analyzed with Cox hazard regression analysis to find a link with survival. Survival curve was generated by Kaplan Meier methods and compared with log rank test. Results: There were statistically significant differences in recipient age (G1: 50.5 yrs., G2: 52.9 yrs., G3: 54.3 yrs.), pre-transplant creatinine (G1: 0.9 mg/dl, G2: 1.25 mg/dl, G3: 1.56 mg/dl), cold ischemic time (G1: 429 min, G2: 446 min, G3; 477min), and warm ischemic time (G1: 37.0 min, G2: 37.8 min, G3; 40.5min). There were no statistically significant differences in demographic factors including donor age, primary liver diagnosis, MELD score, INR, bilirubin, volume of auto-transfusion and cava reconstruction methods between the groups. One, 3, 5 years' patient survival were G1: 92% 86% 80% G2: 87% 79%, 73% and G3: 73% 70% 62%. One, 3, 5 years' graft survival were G1: 92% 86% 79% G2: 83% 73% 68% and G3: 70% 63% 59%. There was statistical difference in patient and graft survival between the groups (p< 0.05). Amounts of transfusion between the groups had survival impact (Hazard ratio 1.3, 95% CI 1.12-1.51, P< 0.05). Conclusion: Recipient age and pre-transplant creatinine had impact on the RBC transfusion volume. To the contrary, recipient MELD score, primary liver disease, donor age and method of caval reconstruction had no significant impact. Amount of transfusion had an impact on the patient and graft survival.Figure: [Patient Survival]