Examining the Association Between Model for End-Stage Liver Disease 3.0 Scores and Intraoperative Blood Component Transfusion During Liver Transplant Surgery.

BACKGROUND

Transfusion during orthotopic liver transplantation (OLT) is frequent and linked to adverse outcomes. However, the ability of the Model for End-Stage Liver Disease (MELD) 3.0 score to predict intraoperative transfusion use has not been well characterized.

METHODS

We performed a single-center retrospective cohort study of 69 adult OLT recipients to evaluate the association between preoperative MELD 3.0 scores and intraoperative transfusion utilization. The primary outcome was total intraoperative blood component use. Secondary outcomes included estimated blood loss (EBL) and use of individual components (packed red blood cells, fresh frozen plasma, platelets, and cryoprecipitate). Analyses used descriptive statistics, Mann-Whitney U tests, and Kruskal-Wallis tests. Multivariable linear regression adjusted for age, birth sex, transplant indication, and preoperative hemoglobin (covariates selected a priori based on clinical relevance). Significance was set at P = .05.

RESULTS

The cohort included 52 men and 17 women (median [IQR] age 57 [46-66] years; median MELD 3.0 score 27 [16-36]). The primary outcome, median intraoperative transfusion volume, was 34 (24-46) blood components. Median EBL was 5500 (3500-8000) mL. In univariable analysis, each one-point increase in MELD was associated with an additional 0.82 blood components transfused (ie, beta coefficient β 0.82; 95% confidence interval [CI], 0.48-1.2; P ≤ .001). In multivariable linear regression adjusted for age, birth sex, indication, and preoperative hemoglobin, higher MELD 3.0 remained independently associated with greater total utilization (β 0.92; 95% CI, 0.48-1.4; P < .001). Women had higher median MELD scores than men (33 [26-36.5] vs 23 [13-36]; P = .05) but similar total transfusion use (34 [24-45] vs 34 [24-46] units; P = .82) and EBL (5500 [4425-7420] vs 5000 [2800-8000] mL; P = .55). By indication, hepatocellular carcinoma (HCC) recipients had lower median MELD scores (13 [8-17]) than alcohol-related (34 [19.8-38], P < .001) or other (27 [21.5-32.5], P = .01) indications. Compared to alcohol-related recipients, HCC recipients received fewer median total blood components (24 [14-44] vs 38 [27-46.8] units, P = .04). EBL did not differ significantly across indications (P = .12).

CONCLUSIONS

Preoperative MELD 3.0 is a robust independent predictor of intraoperative transfusion burden in OLT. Diagnosis-specific patterns-particularly lower transfusion among HCC recipients-support tailoring resource planning by indication and MELD 3.0. Prospective multicenter validation should compare MELD 3.0 against MELD-Na and clinical models to refine prediction of transfusion and evaluate postoperative outcomes.