Prophylactic Use of Fresh Frozen Plasma in Patients Undergoing Liver Resection: Does it Make any Sense?

Abstract

Background: The use of fresh frozen plasma in liver resection has recently been questioned due to the lack of supportive evidence. The aim of the study was to evaluate the clinical impact of a transfusion protocol implemented in our Institution based on the avoidance of prophylactic use of plasma. Methods: 172 adult undergone liver resection were analyzed retrospectively: 104 (study group) underwent surgery between 1/1/2012 and 06/30/2013 and 68 during 2009 (historic group). Prior to the implementation of this protocol in 2009, the prophylactic administration of plasma was a practice in cirrhotic and non-cirrhotic patients when major liver resection was performed. Results: Clinical characteristics, indication and type of resection were similar in both groups. The median of blood loss during surgery was similar. The new protocol induced a significant decrease in the intraoperative use of plasma and red blood cells: none of patients in the study group received plasma whereas 50% of patients in the historic group received a mean of 1000 ml of plasma and the rate of red blood cells transfusion went from 18% to 6% of patients. The overall in-hospital major complication rate was similar. In the historic group the rate of re-intervention was significantly higher (9 vs. 3%, p=0.01) the median in-hospital stay (10 vs. 7, p<0.05). There were no differences in the postoperative residual liver function. Conclusion: In liver resections, the avoidance of routine administration of FFP was not associated to an increase of neither perioperative bleeding nor postoperative complications nor worse liver function.