Background Orthotopic liver transplantation (OLT) may be associated with massive blood loss related to the coexistence of varices, thrombocytopenia or other coagulopathies, or portal hypertension. Piggyback hepatectomy (PGB) is a surgical technique increasingly used in OLT to avoid venovenous bypass and vena cava clamping. This study evaluates the factors associated with blood product requirement with the use of this surgical approach.
Methods We retrospectively reviewed the anesthesia preoperative and operative notes and laboratory values for all adult cadaveric OLTs over a 42-month period (N = 527). Ninety-eight percent of the transplants were performed using a PGB approach with no use of venovenous bypass. A direct entry multivariate regression analyses was performed.
Results Overall median blood loss was 1,000 cc, with the median transfusion rate being PRBCs 3 units, FFP 7 units, and platelets 6 units. Multivariate regression found significant predictors of PRBC transfusion to be male gender, starting Hgb, MELD, age, starting platelets, and a history of major surgery. These results correspond with a mean 1.0 additional unit for males, an additional 0.7 unit for each g/dL Hgb below 11.8, an additional 1.0 unit for each 5 MELD points above 18.1, an additional 0.5 unit for each 10 years age above 52, an additional 0.5 units for each 50,000 platelets below 100,000, and an additional 2.2 units for major surgery versus no surgery.
Conclusions These results demonstrate that, similar to previous reports using venovenous bypass or clamping of the vena cava, certain factors predictably increase the likelihood that blood products will be administered during OLT. Our data also indicate that overall, the PGB technique, typically requiring less warm ischemia time, may represent a safe and cheaper alternative to the conventional approach.
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