Analysis of risk factors of intraoperative blood transfusion during liver transplantation_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

YANG Gengxia , ZENG Daobing ,  LI Guangming

Department of General Surgery, Beijing Youan Hospital, Capital Medical University & Clinical Center for Liver Cancer, Capital Medical University, Beijing 100069, P. R. China;

Corresponding author：

LI Guangming, Email: liguangming@ccmu.edu.cn

Keywords：

liver transplantation; blood transfusion; risk factor

DOI：

10.7507/1007-9424.202203064

Video：

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Objective To explore risk factors of blood transfusion during liver transplantation and construct its prediction model. Methods The patients underwent liver transplantation who met the inclusion and exclusion criteria of this study from March 2020 to December 2020 in the Beijing Youan Hospital of Capital Medical University were retrospectively collected. The univariate and logistic multivariate analysis were used to evaluate the risk factors of blood transfusion during liver transplantation and construct the prediction model for intraoperative blood transfusion. Results A total of 151 eligible liver transplantation patients were collected in this study, including 51 non-transfusion patients and 100 transfusion patients. The univariate analysis results showed that the differences of primary diagnosis, preoperative hemoglobin (Hb), platelet count, prothrombin time, international normalized ratio, Child-Turcotte-Pugh score, and end-stage liver disease (MELD) score were statistically different between them (P<0.05). The above variables selected by the univariate analysis were selected by stepwise method, then the preoperative Hb and MELD score were selected into the multivariate logistic regression analysis, the results showed that the preoperative Hb≤113 g/L and MELD score ＞14 increased the risk of blood transfusion during liver transplantation [Hb: OR=6.652, 95%CI (2.282, 19.392), P<0.001; MELD score: OR=16.037, 95%CI (6.336, 40.592), P<0.001]. The logistic regression model predicted the area under receiver operating characteristic curve was 0.873 [95%CI (0.808, 0.919), P<0.001], the sensitivity and specificity were 91.0% and 67.5%, respectively, Youden index was 0.674, the accuracy was 86.1%. Conclusions Results of this study suggest that preoperative Hb ≤113 g/L and MELD score＞14 increase risk of blood transfusion during liver transplantation. Logistic regression model constructed according to preoperative Hb and MELD score has a better sensitivity and specificity of intraoperative blood transfusion.

Citation： YANG Gengxia, ZENG Daobing, LI Guangming. Analysis of risk factors of intraoperative blood transfusion during liver transplantation. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2022, 29(7): 887-891. doi: 10.7507/1007-9424.202203064 Copy

1.	Stotts MJ, Davis JPE, Shah NL. Coagulation testing and management in liver disease patients. Curr Opin Gastroenterol, 2020, 36(3): 169-176.
2.	Thai C, Oben C, Wagener G. Coagulation, hemostasis, and transfusion during liver transplantation. Best Pract Res Clin Anaesthesiol, 2020, 34(1): 79-87.
3.	Nacoti M, Cazzaniga S, Lorusso F, et al. The impact of perioperative transfusion of blood products on survival after pediatric liver transplantation. Pediatr Transplant, 2012, 16(4): 357-366.
4.	Yoon U, Bartoszko J, Bezinover D, et al. Intraoperative transfusion management, antifibrinolytic therapy, coagulation monitoring and the impact on short-term outcomes after liver transplantation—A systematic review of the literature and expert panel recommendations. Clin Transplant, 2022: e14637. doi: 10.1111/ctr.14637.
5.	Kasraian L, Nikeghbalian S, Karimi MH. Blood product transfusion in liver transplantation and its impact on short-term survival. Int J Organ Transplant Med, 2018, 9(3): 105-111.
6.	Pustavoitau A, Rizkalla NA, Perlstein B, et al. Validation of predictive models identifying patients at risk for massive transfusion during liver transplantation and their potential impact on blood bank resource utilization. Transfusion, 2020, 60(11): 2565-2580.
7.	Viguera L, Blasi A, Reverter E, et al. Baseline haemoglobin and thromboelastometry are predictive of red blood cell requirements and one-year mortality in liver transplantation. Transfus Apher Sci, 2021, 60(6): 103259. doi: 10.1016/j.transci.2021.103259.
8.	Brustia R, Monsel A, Conti F, et al. Enhanced recovery in liver transplantation: a feasibility study. World J Surg, 2019, 43(1): 230-241.
9.	Koh A, Adiamah A, Gomez D, et al. Safety and efficacy of tranexamic acid to minimise perioperative bleeding in hepatic surgery: a systematic review and meta-analysis. World J Surg, 2022, 46(2): 441-449.
10.	Ramos E, Dalmau A, Sabate A, et al. Intraoperative red blood cell transfusion in liver transplantation: influence on patient outcome, prediction of requirements, and measures to reduce them. Liver Transpl, 2003, 9(12): 1320-1327.
11.	臧运金, 郭源, 李自强, 等. 无输血肝移植手术4例. 中国现代普通外科进展, 2006, 9(1): 59-59.
12.	de Souza JR, Yokoyama AP, Magnus MM, et al. Association of acidosis with coagulopathy and transfusion requirements in liver transplantation. J Thromb Thrombolysis. 2021 Nov 20. doi: 10.1007/s11239-021-02609-x.
13.	Yoon JU, Byeon GJ, Park JY, et al. Bloodless living donor liver transplantation: risk factors, outcomes, and diagnostic predictors. Medicine (Baltimore), 2018, 97(50): e13581. doi: 10.1097/MD.0000000000013581.
14.	Findlay JY, Rettke SR. Poor prediction of blood transfusion requirements in adult liver transplantations from preoperative variables. J Clin Anesth, 2000, 12(4): 319-323.
15.	Hendriks HG, van der Meer J, Klompmaker IJ, et al. Blood loss in orthotopic liver transplantation: a retrospective analysis of transfusion requirements and the effects of autotransfusion of cell saver blood in 164 consecutive patients. Blood Coagul Fibrinolysis, 2000, 11 Suppl 1: S87-S93. doi: 10.1097/00001721-200004001-00017.
16.	Deakin M, Gunson BK, Dunn JA, et al. Factors influencing blood transfusion during adult liver transplantation. Ann R Coll Surg Engl, 1993, 75(5): 339-344.
17.	Alsebaey A, Sabry A, Rashed HS, et al. MELD-sarcopenia is better than ALBI and MELD score in patients with hepatocellular carcinoma awaiting liver transplantation. Asian Pac J Cancer Prev, 2021, 22(7): 2005-2009.
18.	Vagefi PA, Bertsimas D, Hirose R, et al. The rise and fall of the model for end-stage liver disease score and the need for an optimized machine learning approach for liver allocation. Curr Opin Organ Transplant, 2020, 25(2): 122-125.
19.	Ruf A, Dirchwolf M, Freeman RB. From Child-Pugh to MELD score and beyond: taking a walk down memory lane. Ann Hepatol, 2022, 27(1): 100535. doi: 10.1016/j.aohep.2021.100535.
20.	Acharya C, Bajaj JS. Hepatic encephalopathy and liver transplantation: the past, present, and future toward equitable access. Liver Transpl, 2021, 27(12): 1830-1843.
21.	陈杰, 李平, 刘婷婷, 等. 肝移植术中大量输血的影响因素分析及预测模型构建. 中华器官移植杂志, 2021, 42(1): 29-33.
22.	Varotti G, Santori G, Andorno E, et al. Impact of model for end-stage liver disease score on transfusion rates in liver transplantation. Transplant Proc, 2013, 45(7): 2684-2688.
23.	Massicotte L, Beaulieu D, Roy JD, et al. MELD score and blood product requirements during liver transplantation: no link. Transplantation, 2009, 87(11): 1689-1694.
24.	Roullet S, Biais M, Millas E, et al. Risk factors for bleeding and transfusion during orthotopic liver transplantation. Ann Fr Anesth Reanim, 2011, 30(4): 349-352.

1. Stotts MJ, Davis JPE, Shah NL. Coagulation testing and management in liver disease patients. Curr Opin Gastroenterol, 2020, 36(3): 169-176.
2. Thai C, Oben C, Wagener G. Coagulation, hemostasis, and transfusion during liver transplantation. Best Pract Res Clin Anaesthesiol, 2020, 34(1): 79-87.
3. Nacoti M, Cazzaniga S, Lorusso F, et al. The impact of perioperative transfusion of blood products on survival after pediatric liver transplantation. Pediatr Transplant, 2012, 16(4): 357-366.
4. Yoon U, Bartoszko J, Bezinover D, et al. Intraoperative transfusion management, antifibrinolytic therapy, coagulation monitoring and the impact on short-term outcomes after liver transplantation—A systematic review of the literature and expert panel recommendations. Clin Transplant, 2022: e14637. doi: 10.1111/ctr.14637.
5. Kasraian L, Nikeghbalian S, Karimi MH. Blood product transfusion in liver transplantation and its impact on short-term survival. Int J Organ Transplant Med, 2018, 9(3): 105-111.
6. Pustavoitau A, Rizkalla NA, Perlstein B, et al. Validation of predictive models identifying patients at risk for massive transfusion during liver transplantation and their potential impact on blood bank resource utilization. Transfusion, 2020, 60(11): 2565-2580.
7. Viguera L, Blasi A, Reverter E, et al. Baseline haemoglobin and thromboelastometry are predictive of red blood cell requirements and one-year mortality in liver transplantation. Transfus Apher Sci, 2021, 60(6): 103259. doi: 10.1016/j.transci.2021.103259.
8. Brustia R, Monsel A, Conti F, et al. Enhanced recovery in liver transplantation: a feasibility study. World J Surg, 2019, 43(1): 230-241.
9. Koh A, Adiamah A, Gomez D, et al. Safety and efficacy of tranexamic acid to minimise perioperative bleeding in hepatic surgery: a systematic review and meta-analysis. World J Surg, 2022, 46(2): 441-449.
10. Ramos E, Dalmau A, Sabate A, et al. Intraoperative red blood cell transfusion in liver transplantation: influence on patient outcome, prediction of requirements, and measures to reduce them. Liver Transpl, 2003, 9(12): 1320-1327.
11. 臧运金, 郭源, 李自强, 等. 无输血肝移植手术4例. 中国现代普通外科进展, 2006, 9(1): 59-59.
12. de Souza JR, Yokoyama AP, Magnus MM, et al. Association of acidosis with coagulopathy and transfusion requirements in liver transplantation. J Thromb Thrombolysis. 2021 Nov 20. doi: 10.1007/s11239-021-02609-x.
13. Yoon JU, Byeon GJ, Park JY, et al. Bloodless living donor liver transplantation: risk factors, outcomes, and diagnostic predictors. Medicine (Baltimore), 2018, 97(50): e13581. doi: 10.1097/MD.0000000000013581.
14. Findlay JY, Rettke SR. Poor prediction of blood transfusion requirements in adult liver transplantations from preoperative variables. J Clin Anesth, 2000, 12(4): 319-323.
15. Hendriks HG, van der Meer J, Klompmaker IJ, et al. Blood loss in orthotopic liver transplantation: a retrospective analysis of transfusion requirements and the effects of autotransfusion of cell saver blood in 164 consecutive patients. Blood Coagul Fibrinolysis, 2000, 11 Suppl 1: S87-S93. doi: 10.1097/00001721-200004001-00017.
16. Deakin M, Gunson BK, Dunn JA, et al. Factors influencing blood transfusion during adult liver transplantation. Ann R Coll Surg Engl, 1993, 75(5): 339-344.
17. Alsebaey A, Sabry A, Rashed HS, et al. MELD-sarcopenia is better than ALBI and MELD score in patients with hepatocellular carcinoma awaiting liver transplantation. Asian Pac J Cancer Prev, 2021, 22(7): 2005-2009.
18. Vagefi PA, Bertsimas D, Hirose R, et al. The rise and fall of the model for end-stage liver disease score and the need for an optimized machine learning approach for liver allocation. Curr Opin Organ Transplant, 2020, 25(2): 122-125.
19. Ruf A, Dirchwolf M, Freeman RB. From Child-Pugh to MELD score and beyond: taking a walk down memory lane. Ann Hepatol, 2022, 27(1): 100535. doi: 10.1016/j.aohep.2021.100535.
20. Acharya C, Bajaj JS. Hepatic encephalopathy and liver transplantation: the past, present, and future toward equitable access. Liver Transpl, 2021, 27(12): 1830-1843.
21. 陈杰, 李平, 刘婷婷, 等. 肝移植术中大量输血的影响因素分析及预测模型构建. 中华器官移植杂志, 2021, 42(1): 29-33.
22. Varotti G, Santori G, Andorno E, et al. Impact of model for end-stage liver disease score on transfusion rates in liver transplantation. Transplant Proc, 2013, 45(7): 2684-2688.
23. Massicotte L, Beaulieu D, Roy JD, et al. MELD score and blood product requirements during liver transplantation: no link. Transplantation, 2009, 87(11): 1689-1694.
24. Roullet S, Biais M, Millas E, et al. Risk factors for bleeding and transfusion during orthotopic liver transplantation. Ann Fr Anesth Reanim, 2011, 30(4): 349-352.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Analysis of risk factors of intraoperative blood transfusion during liver transplantation

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