• Luc Massicotte, François Martin Carrier, André Y Denault, Pierre Karakiewicz, Zoltan Hevesi, Mickael McCormack, Lynda Thibeault, Anna Nozza, Zhe Tian, Michel Dagenais, and André Roy.
• Anesthesiology Department, Centre Hospitalier de l'Université de Montréal (CHUM), Hôpital St-Luc, Montreal, QC, Canada. Electronic address: luc.massicotte@umontreal.ca.
• J. Cardiothorac. Vasc. Anesth. 2018 Aug 1; 32 (4): 1722-1730.

ObjectiveOrthotopic liver transplantation (OLT) frequently is associated with major blood loss and considerable transfusion requirements. The goal of this study was to define the risk factors for multiple transfusions and major bleeding during OLT and to help identify higher risk patients that could benefit from targeted interventions.DesignOLTs were studied for this observational cohort study.SettingCommunity hospital.ParticipantsA total of 800 consecutive OLTs were studied.InterventionNo intervention.Measurements And Main ResultsBaseline and intraoperative data were gathered. Multivariate logistic regression analyses were performed to find variables associated with 2 outcomes: transfusion of more than 2 units of red blood cells (RBC) and bleeding ≥900 mL. Two nomograms were developed to predict individual risks. The overall intraoperative RBC transfusion was 0.6 ± 1.4 units on average, and 61 surgeries (7.6%) received more than 2 units of RBC (4.5 ± 1.9). Some variables were associated with the outcomes: 5 were associated with transfusion of more than 2 units of RBC (patient's height, starting hemoglobin concentration, starting bilirubin value, the use of a phlebotomy, and central venous pressure [CVP] at the time of vena cava clamping) and 3 with blood loss of ≥900 mL (starting hemoglobin value, Child-Turcotte-Pugh score, and CVP at the time of vena cava clamping). Preclamping CVP showed the strongest association with both outcomes. Nomograms were developed to predict the individual OLT recipients' risk of requiring more than 2 units RBC and suffering from major bleeding. Among the variables associated with multiple RBC transfusions and major bleeding, 3 can lead to interventions: baseline hemoglobin value, the use of a phlebotomy, and the preclamping CVP.ConclusionSome variables were able to predict the risk of multiple transfusions and major bleeding in this low bleeding liver transplantation population. Further studies based on these variables should be done to better define the role of targeted interventions in higher risk liver transplant recipients.Copyright © 2017 Elsevier Inc. All rights reserved.

23 keywords...

hide…