Abstract
Introduction. This study's objective was to identify risk factors associated with reoperation for bleeding following liver transplantation (LTx). Methods. A retrospective study was performed at a single institution between 2001 and 2012. Operative reports were used to identify patients who underwent reoperation for bleeding within 2 weeks following LTx (operations for nonbleeding etiologies were excluded). Results. Reoperation for bleeding was observed in 101/928 (10.8%) of LTx patients. The following characteristics were associated with reoperation on multivariable analysis: recipient MELD score (OR 1.06/MELD unit, 95% CI 1.03, 1.09), number of platelets transfused (OR 0.73/platelet unit, 95% CI 0.58, 0.91), and aminocaproic acid utilization (OR 0.46, 95% CI 0.27, 0.80). LTx patients who underwent reoperation for bleeding had a longer ICU stay (5 days ± 7 versus 2 days ± 3, P < 0.001) and hospitalization (18 days ± 9 versus 10 days ± 18, P < 0.001). The risk of death increased in patients who underwent reoperation for bleeding (HR 1.89, 95% CI 1.26, 2.85). Conclusion. Reoperation for bleeding following LTx was associated with increased resource utilization and recipient mortality. A lower threshold for intraoperative platelet transfusion and antifibrinolytics, especially in patients with high lab-MELD score, may decrease the incidence of reoperation for bleeding following LTx.
Highlights
This study’s objective was to identify risk factors associated with reoperation for bleeding following liver transplantation (LTx)
Despite advances in anesthesia and surgical techniques manifesting in lower overall transfusion requirements [3, 4], bleeding is still the most frequent serious early complication following liver transplantation, occurring in approximately 20% of patients [5]
The average labMELD score at the time of transplantation was significantly higher in the reoperation for bleeding group compared to the control group (23.8 ± 8.1 versus 20.4 ± 7.9, P < 0.001)
Summary
This study’s objective was to identify risk factors associated with reoperation for bleeding following liver transplantation (LTx). Reoperation for bleeding following LTx was associated with increased resource utilization and recipient mortality. A lower threshold for intraoperative platelet transfusion and antifibrinolytics, especially in patients with high lab-MELD score, may decrease the incidence of reoperation for bleeding following LTx. Approaches to the perioperative management for liver transplantation have been adapted over time. Experience with liver transplantation focused on the management of coagulopathy and involved extraordinary utilization of blood component therapy [1, 2]. Despite advances in anesthesia and surgical techniques manifesting in lower overall transfusion requirements [3, 4], bleeding is still the most frequent serious early complication following liver transplantation, occurring in approximately 20% of patients [5]. Much variability exists between institutions with regard to coagulopathy management suggesting the need for more evidence to guide practice [2, 10, 11]
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