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Canadian Journal of Anesthesia

, Volume 48, Issue 11, pp 1075–1079 | Cite as

Intraoperative blood losses and transfusion requirements during adult liver transplantation remain difficult to predict

  • A. Steib
  • G. Freys
  • C. Lehmann
  • C. Meyer
  • G. Mahoudeau
General anesthesia

Abstract

Purpose

To identify preoperative factors associated with high blood losses during liver transplantation for chronic endstage liver disease.

Methods

Four hundred and ten consecutive patients were included in this retrospective study. Blood losses were calculated, based on transfusion requirements. The population was divided into two groups: the upper quartile was defined as the high blood loss (HBL) group and the lower three quartiles as the low blood loss group. Fourteen preoperative variables were collected. Qualitative variables consisted of the type of hepatopathy, Child-Pugh’s classification, sex, the surgical team’s experience, previous abdominal surgery and portal hypertension. Quantitative variables were age, hemoglobin concentration Hb, platelet count, prothrombin time, activated partial thromboplastin time, fibrinogen concentration, fibrin degradation products (FDP) and euglobulin lysis time. Univariate analysis and stepwise multivariate analysis were conducted.

Results

Patients in the HBL group required 12 units of red blood cell or more to maintain a Hb ≥ 100g·L−1. HBL was associated with severe liver disease, previous abdominal surgery, use of a venovenous bypass and little surgical experience in orthotopic liver transplantation (OLT). In the HBL group several hemostatic parameters were more disturbed before surgery. The multivariate analysis disclosed three independent variables associated with HBL: Hb and FDP concentrations and previous upper abdominal surgery. When combined, these resulted in a high specificity (98%) but low sensitivity to predict blood loss.

Conclusion

Despite our efforts we were unable to identify predictive risk factors of bleeding during OLT even in a homogeneous population. Centres should evaluate their practice individually in an attempt to identify patients at high risk of being transfused.

Keywords

Positive Predictive Value Orthotopic Liver Transplantation Transfusion Requirement Fibrin Degradation Product High Blood Loss 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Les pertes sanguines peropératoires et les besoins transfusionnels restent toujours difficiles à prédire pendant la greffe du foie

Résumé

Objectif

Découvrir les facteurs préopératoires associés à d’importantes pertes sanguines survenant pendant la greffe du foie pour maladie chronique du foie au stade ultime.

Méthode

Quatre cent dix patients successifs ont participé à une étude rétrospective. Les pertes sanguines ont été calculées d’après les besoins transfusionnels. Les participants ont été divisés en deux groupes: le quartile supérieur étant le groupe de perte sanguine élevée (PSE) et les trois quartiles inférieurs, le groupe de perte sanguine faible (PSF). Des 14 variables préopératoires rassemblées, les variables qualitatives ont été: le type d’hépatopathie, la classification de Child-Pugh, le sexe, l’expérience de l’équipe chirurgicale, les interventions abdominales antérieures et l’hypertension portale; les variables quantitatives ont été: l’âge, le taux d’hémoglobine (Hb), la numération plaquettaire, le temps de prothrombine, le temps de céphaline activé, la concentration en fibrinogène, les produits de dégradation de la fibrine (PDF) et le temps de lyse des euglobulines. L’analyse univariée et l’analyse multivariée séquentielle ont été réalisées.

Résultats

Les patients du groupe PSE ont eu besoin de 12 unités de globules rouges ou plus pour maintenir une [Hb] ≥ 100g·L−1. La PSE a été associée à: une maladie hépatique sévère, une intervention abdominale antérieure, l’utilisation d’une dérivation veino-veineuse et peu d’expérience en greffe du foie orthotopique (GFO). Dans le groupe de PSE, certains paramètres hémostatiques étaient plus instables avant l’opération. L’analyse multivariée a révélé trois variables indépendantes associées à la PSE: les concentrations d’Hb et de PDF et les interventions abdominales hautes antérieures. Les résultats combinés présentent une forte spécificité (98 %) mais une faible sensibilité à prédire les pertes sanguines.

Conclusion

Malgré nos efforts, nous n’avons pu déterminer les facteurs de risque prédictifs de saignements pendant la greffe de foie orthotopique chez une population homogène. Les hôpitaux doivent évaluer leur pratique individuelle afin de découvrir les patients à risque d’être transfusés.

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Copyright information

© Canadian Anesthesiologists 2001

Authors and Affiliations

  • A. Steib
    • 1
  • G. Freys
    • 1
  • C. Lehmann
    • 1
  • C. Meyer
    • 2
  • G. Mahoudeau
    • 1
  1. 1.Department of AnaesthesiaHôpitaux UniversitairesStrasbourgFrance
  2. 2.Department of TransplantationHôpitaux UniversitairesStrasbourgFrance

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