Massive blood transfusion: risk factors and consequences
Alberto Marcacuzco Quinto1, Clara Fernandez Fernandez1, Blanca Torreón1, Oscar Caso1, Jorge Calvo1, Alejandro Manrique1, Alvaro Garcia Sesma1, Carmelo Loinaz Segurola1, Carlos Jimenez Romero1, Iago Justo Alonso1.
1Unit HPB and Liver transplantation, 12 de Octubre Hospital, Madrid, Spain
Introduction: Massive blood transfusion (MBT) is a common occurrence in liver transplant patients. Recipient-related risk factors include cirrhosis, history of multiple surgeries and suboptimal donors. And, while advances in surgical techniques, anaesthetic management and graft preservation have decreased the need for transfusions, this complication has not been completely eliminated.
Materials and Methods: One thousand four hundred and sixty nine liver transplants were performed at our institution between May 1998 and December 2019, and data was available regarding transfusion for 1469 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 hours post transplant, and we analyzed the differences between the groups. We analyzed the risk factors for massive transfusion, as well as factors that influence patient survival by using Cox regression.
Results: Out of the 1198 patients, 607 (50.7%) met criteria for massive transfusion.Both groups were statistically different with regards to hepatocellular carcinoma, autoimmune cause, liver/kidney transplant, uDCD, retransplantation, albumin serum levels, creatinine, sodium, bilirubin, haemoglobin, platelets, INR, MELD, McCluskey and Child scores. Out of the variables from the McCluskey index, only the following were significant for massive bleeding: Haemoglobin <10, INR >2 and creatinine >1.2. We contrasted the efficiency of all of the previously mentioned scores for capacity to predict massive transfusion, but none reached an area below the curve above 0.7. Survival was statistically lower at 1, 3, and 5 years when comparing the groups that had MBT compared 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). Regarding survival analysis, MBT was associated with a 1.5 mortality risk as opposed to no MBT.
Conclusion: Massive blood transfusion impacts patient survival in a statistically significant way. The most significant risk factors are preoperative haemoglobin, INR and creatinine.
