The association between perioperative blood product transfusion and outcomes following orthotopic liver transplantation

Abstract

There is controversy regarding the effect of blood product transfusion on patients undergoing liver transplantation. De Boer et al. suggested an association between platelet transfusion and increased mortality in liver transplantation. This thesis evaluates the consequences of blood transfusion during the intraoperative and postoperative period in liver transplant recipients. A retrospective multivariate analysis of data involving 434 liver transplant recipients at our institution from 2002 to 2011 was conducted. The primary outcomes were patient and graft survival rates at 1 and 5 years following liver transplantation. The secondary outcomes included the incidence of postoperative acute kidney injury (AKI) / dialysis and postoperative infection and the duration of endotracheal intubation, intensive care unit (ICU) stay and hospital stay. Transfusion of ≥5 units of pooled platelets was associated with decreased 5- year patient mortality and 5-year graft failure. Platelet transfusion was also associated with an increased incidence of postoperative AKI, infective complications, and duration of endotracheal intubation. Packed red blood cell transfusion (PRBC) was not associated with increased mortality or graft failure. PRBC transfusion was associated with an increased incidence of AKI. Fresh frozen plasma transfusion was associated with increased 5-year patient mortality, duration of endotracheal intubation and duration of hospital stay. The transfusion of cryoprecipitate was not associated with increased mortality or graft failure following liver transplantation but was associated with an increased ICU stay when ≥20 units were administered. This thesis demonstrated that the transfusion of platelets was associated with decreased long-term patient mortality and graft failure following liver transplantation. This contrasts to previous studies which linked blood product transfusion to increased patient mortality and graft failure.