Transfusion requirements in living donor liver transplantation – Role of laboratory assessment and Model For End Stage Liver Disease (MELD) score

Abstract

Introduction and aimsLiver transplant surgery is often associated with considerable bleeding. This study was undertaken to analyse the average blood component consumption and the effectiveness of preoperative laboratory assessment and Model For End Stage Liver Disease (MELD) score in the estimation of transfusion requirements in Living Donor Liver Transplantation (LDLT). Material and methodsUnivariate and stepwise regression analysis were employed to establish the significance of correlation of the preoperative laboratory variables, including haematocrit, platelet count, INR, total bilirubin, serum creatinine, blood urea and MELD score with the total consumption of Packed Red Cells (PRCs), cryoprecipitates, aphaeresis platelets and Fresh Frozen Plasma (FFP). Stepwise discriminant analysis was used to identify those preoperative factors which have a significant predictive value for the total consumption of each blood component and these results were employed to construct separate prediction models for the utilization of each blood component and the respective R square values were determined. ResultsA total of 509 patients were included. On an average, 8.44 units (SD = 6.11) of PRCs, 2.58 units (SD = 2.95) of cryoprecipitates, 0.81 units (SD = 1.16) of aphaeresis platelets and 2074.85 ml (SD = 1240.20) of FFP were consumed per LDLT. The blood component prediction models could be employed to accurately predict the total utilisation of PRCs, cryoprecipitates, FFP and aphaeresis platelets in 23, 22.6, 17.8 and 20.7 per cent of our patients, respectively. ConclusionWe have been able to identify those preoperative factors which can be employed to predict the consumption of various blood components in living donor liver graft recipients. These variables were further employed to construct prediction models, separately for each blood component. We also identified those preoperative variables which significantly influence the in hospital mortality and PLOS in LDLT recipients.