Evaluation of correlation between etiology of end stage liver disease and intraoperative utilization of blood products during liver transplantation.

BACKGROUND

Liver transplantation is frequently associated with massive blood loss and utilization of blood products to optimize coagulation; this study aimed to evaluate their possible correlation with etiological and perioperative factors.

METHODS

A retrospective analysis of adult liver transplant (LT) recipients (excluding re-do transplants) operated upon at our center between 2011 and 2021 was conducted using R package with rBiostatistics.com graphical user interface.

RESULTS

Of the 947 cases, 70.70% had cirrhosis, and 28.6% hepatocellular carcinoma, as secondary diagnoses; the most common primary diagnosis was viral hepatitis (B = 20.9% and C = 20.0%). The mean blood loss volume was 3393.2 ml. Living donor liver transplantation (LDLT) recipients (n = 740, 78.2%) had lesser blood loss (mean difference 738 mL, P = 0.037) and reduced requirement for fresh frozen plasma (FFP, OR = 0.734, P = 0.001) and platelets (OR = 0.809, P < 0.001). Presence of hepatocellular carcinoma (n = 273, 28.6%) was significantly protective for blood loss (mean difference 717 ml, P = 0.037) and the need for FFP (OR = 0.991, P < 0.001), cryoprecipitate (OR = 0.568, P = 0.001), and platelets (OR = 0.602, P < 0.001). Schistosomiasis (n = 23, 2.4%) was accompanied by increased blood loss (mean difference 2328 ml (P = 0.012)). A body mass index (BMI) >35 kg/m2 increased the hazard of cryoprecipitate requirement (OR = 1.203, P = 0.008).

CONCLUSION

The blood loss and the blood products transfusion requirements in LT are influenced by the etiology, graft type, and other perioperative factors such as BMI.