Risk factors of massive blood transfusion in liver transplantation: consequences and a new index for prediction including the donor

Background Massive blood transfusion (MBT) is a common occurrence in liver transplant (LT) patients. Recipient-related risk factors include cirrhosis, history of multiple surgeries and suboptimal donors. Despite advances in surgical techniques, anesthetic management and graft preservation have decreased the need for transfusions, this complication has not been completely eliminated. Methods One thousand four hundred and sixty-nine LT were performed at our institution between May 2003 and December 2020, and data was available regarding transfusion for 1198 of them. We divided the patients into two groups, with regards to transfusion of 6 or more units of packed red blood cells in the first 24 h posttransplant, and we analyzed the differences between the groups. Results Out of the 1198 patients, 607 (50.7%) met criteria for MBT. Survival was statistically lower at 1, 3, and 5 years when comparing the groups that had MBT to those that did not (92.6%, 85.2% and 79.7%, respectively, in the non MBT group, vs. 78.1%, 71.6% y 66.8%, respectively, in the MBT group). MBT was associated with a 1.5 mortality risk as opposed to non-MBT patients. Logistical regression analysis of our variables yielded the following results for a new model, including serum creatinine (OR 1.97), sodium (OR 1.73), hemoglobin (OR 1.99), platelets (OR 1.37), INR (OR 1.4), uDCD (OR 2.13) and split liver donation. Conclusion Massive blood transfusion impacts patient survival in a statistically significant way. The most significant risk factors are preoperative hemoglobin, INR and serum creatinine.

背景 大量输血（MBT）在肝移植（LT）患者中较为常见。受者相关的风险因素包括肝硬化、多次手术史以及供体不理想。尽管手术技术、麻醉管理和移植物保存方面取得了进展，减少了输血需求，但这一并发症尚未完全消除。 方法 2003年5月至2020年12月期间，我们机构共进行了1469例肝移植手术，其中1198例有输血相关数据。我们根据移植后24小时内输注6个或更多单位浓缩红细胞的情况将患者分为两组，并分析了两组之间的差异。 结果 在1198例患者中，607例（50.7%）符合大量输血标准。将大量输血组与未大量输血组进行比较，1年、3年和5年生存率在统计学上更低（未大量输血组分别为92.6%、85.2%和79.7%，而大量输血组分别为78.1%、71.6%和66.8%）。与未大量输血的患者相比，大量输血的死亡风险为1.5。对我们的变量进行逻辑回归分析，得出一个新模型的如下结果，包括血清肌酐（比值比1.97）、钠（比值比1.73）、血红蛋白（比值比1.99）、血小板（比值比1.37）、国际标准化比值（比值比1.4）、心脏死亡后器官捐献（比值比2.13）以及劈离式肝脏捐献。 结论 大量输血对患者生存率有统计学上的显著影响。最显著的风险因素是术前血红蛋白、国际标准化比值和血清肌酐。