title: Intraoperative blood loss during living donor liver transplantation: an analysis of 635 recipients at a single center.
abstract: BACKGROUND
  Living-donor liver transplantation (LDLT) has been an important option in the treatment of patients with end-stage liver disease. Massive intraoperative blood loss can occur during LDLT, necessitating blood transfusion. The purpose of this study was to present blood loss data from the recipients of LDLT, to assess the effect of massive intraoperative blood loss on prognosis, and to assess the reliability of preoperative information in predicting intraoperative blood transfusion requirements in LDLT.
  
  
  METHODS
  A total of 635 patients who underwent LDLTs between January 1995 and March 2002 at a university hospital were retro- spectively investigated. The volume of blood loss, prognosis, and preoperative variables were analyzed statistically.
  
  
  RESULTS
  Intraoperative blood loss ranged from 5.15 to 1980 mL per kg (mean, 136 mL/kg). Massive blood loss negatively affected survival not only immediately after operation (high blood loss [HBL]:low blood loss [LBL] ratio, 85.5%:93.9% at 1 month) but also over the long term (HBL:LBL, 61.4%:76.8% at 5 years). Preoperative risk factors for massive blood loss were determined to be recipient age (<1 years), weight (<10 kg), C-reactive protein (>2 mg/dL), hematocrit (<30%), total bilirubin (>20.0 mg/dL), direct bilirubin (>16.0 mg/dL), and blood urea nitrogen levels (>30.0 mg/dL).
  
  
  CONCLUSIONS
  The risk factors associated with massive intraoperative blood loss during LDLT were identified. This is the first analysis of blood loss during LDLT at a single center. Massive blood loss is a predictor of poor prognosis in LDLT patients.
authors.affiliation: Department of Transfusion Medicine and Cell Therapy, Kyoto University Hospital, Kyoto, Japan. yuasa@kuhp.kyoto-u.ac.jp
authors.forename: Takeshi
authors.initials: T
authors.lastname: Yuasa
authors.forename: Norimi
authors.initials: N
authors.lastname: Niwa
authors.forename: Shinya
authors.initials: S
authors.lastname: Kimura
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Tsuji
authors.forename: Kimiko
authors.initials: K
authors.lastname: Yurugi
authors.forename: Hiroto
authors.initials: H
authors.lastname: Egawa
authors.forename: Koichi
authors.initials: K
authors.lastname: Tanaka
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Asano
authors.forename: Taira
authors.initials: T
authors.lastname: Maekawa
mesh_terms: D017677:Age Distribution; D016063:Blood Loss, Surgical; D001803:Blood Transfusion; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007564:Japan; D016031:Liver Transplantation / Q000401:mortality*; D019520:Living Donors; D008297:Male; D012189:Retrospective Studies; D012307:Risk Factors; D016019:Survival Analysis; D016896:Treatment Outcome