Predictors of massive blood transfusion in liver transplantation for patients with benign end-stage liver disease

Abstract

To identify the predictors of massive blood transfusion in liver transplantation for patients with benign end-stage liver disease (ESLD). The clinical data of 268 patients with ESLD mainly caused by hepatitis B who were to receive cadaver liver transplantation performed by 5 groups of anesthesiologists respectively were retrospectively reviewed. The patients were divided into 2 groups according to the transfusion amount: massive blood transfusion (MBT) group (n = 120) receiving the blood transfusion of more than 12 units of red blood cells (RBCs) during the operation, and non-massive blood transfusion (NBT) group (n = 148). Univariate analysis and stepwise logistic regression were used. The influence of anesthesiologists on administration of blood cells was analyzed. During the liver transplantation, 98.13% of the patients received RBC transfusion of the mean dose of 13.32 units. Different group of anesthesiologists exerted no influence on the amount of RBC transfusion. Logistic regression showed that the preoperative MELD score, hemoglobin, platelet, interactional normalized ratio of prothrombin time, kaolin partial thromboplastin time, total protein, serum creatinine, total bilirubin, ascite, and severity of hepatitis were risk factors of MBT. Multivariable logistic regression showed that 2 independent predictors of MBT were identified: preoperative MELD score and hemoglobin. Accordingly, MBT during liver transplantation was predicted by 0.593 - 0.049 x preoperative hemoglobin + 0.137 x preoperative MELD score, with a cut off value of -0.67, a sensitivity of 84.1% and a specify of 71.2%. The area under receiver operating characteristic curves of prognostic score was 0.832. MBT during liver transplantation can be predicted by preoperative MELD score and hemoglobin value in patients with ESLD secondary to type B hepatitis.