Background: Liver transplantation (LT) maybe associated with massive blood loss due to the complex hemostatic abnormalities of end-stage liver disease (ESLD) and surgical complexity. Blood transfusions have been associated with complications including increased risk for infection, multi-organ dysfunction, graft loss and mortality.

Objective: We sought to determine whether a correlation exists between pre-operative anemia and increased transfusion requirements in LT, hospital length of stay (LOS) and incidence of post-operative infection.

Methods: A retrospective review of solitary LT patients between 1/1/12 and 6/30/15 was conducted. Number of units of packed red blood cells (PRBC), fresh frozen plasma (FFP), platelets, and cryoprecipitate (CRY) pre-tx, during tx, and in the first 48 hours post-tx were collected. Cox Proportional Hazard model was used to model the outcome of infection. Linear regression was used to model the outcomes of post-tx LOS and blood product units.

Results: Of the 112 transplants included, 62% male, 25% DCD organs, 1.8% re-transplants, and 45.5% had a previous abdominal surgery. Mean age was 56±10 years, mean MELD at removal for transplant was 27±8, and mean pre-tx hemoglobin (HGB) was 10.5±2.4. Lower pre-tx HGB was significantly associated with increased blood products given prior to and during transplant, except for pre-tx FFP (p=0.07). Increased units for pre-tx PRBC, FFP, and platelets and intra-op PRBCs were all associated with longer post-tx LOS. Each g/dl unit decrease in pre-tx HGB was associated with a 26% increased risk of infection post-tx in univariate models (HR=1.26, p=0.01). Other factors associated with an increased risk of infection post-tx in univariate models were longer total LOS, a higher number of pre-op CRY units, higher number of intra-op FFP units, and higher number of post-op FFP. More units of pre-op CRY (HR=1.07, p<0.01), fewer units of post-op CRY (HR=0.19, p<0.01), and more units of post-op FFP (HR=1.75, p<0.01) were associated with post-tx infection in multivariable stepwise selection.

Conclusion: Pre-tx HGB was associated with increased blood given pre-tx and during transplant. More units of CRY pre-tx, fewer CRY units and more FFP units given post-tx were independent predictors of infection post-tx. We plan to institute a protocol for treating perioperative anemia in our liver transplant patient population.

CITATION INFORMATION: Aldag E, Moghimi P, Pedersen R, Sahajpal A, Clendenon J, Gunabushanam V, Irani M, Kramer D. Evaluation of Perioperative Anemia and Associated Transfusion Requirements in Adult Liver Transplant Recipients. Am J Transplant. 2016;16 (suppl 3).

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