A comparison of transfusion requirements between living donation and cadaveric donation liver transplantation: relationship to model of end-stage liver disease score and baseline coagulation status.
The use of living donation is an important option for patients in need of liver transplant. We retrospectively reviewed the preoperative Model for End-Stage Liver Disease (MELD) score, baseline coagulation laboratory results, and intraoperative transfusion of red blood cells and component therapy for 27 living donation transplants and 69 cadaveric donation transplants during a 3-yr period (2001-2004). Patients undergoing living donation transplantation had significantly lower MELD scores and preserved coagulation function compared with cadaveric donation transplantation recipients (P < 0.001). The living donation transplant patients also received significantly fewer transfusions of red blood cells and component therapy compared with the cadaveric donation transplant patients (P < 0.001). For the combined population of both cadaveric donation transplant and living donation transplant patients, there were significant associations between MELD score and preoperative coagulation tests (P < 0.001) and intraoperative transfusion of blood and component therapy. MELD score and preoperative fibrinogen concentration were identified as independent predictors of transfusion exposure. In conclusion, we detected significant differences in severity of disease at time of transplantation, degree of impairment of coagulation function, and need for transfusion of red blood cells and component therapy between patients undergoing living donation transplantation compared with patients undergoing cadaveric donation transplantation.
Mayo Clinic College of Medicine, Department of Anesthesiology, Mayo Clinic Scottsdale, 13400 E. Shea Blvd., Scottsdale, AZ 85259, USA. frasco.peter@mayo.edu
Peter E
PE
Frasco
Karl A
KA
Poterack
Joseph G
JG
Hentz
David C
DC
Mulligan
D001777:Blood Coagulation / Q000502:physiology*; D001780:Blood Coagulation Tests; D016913:Blood Component Transfusion; D006801:Humans; D019934:International Normalized Ratio; D008107:Liver Diseases / Q000503:physiopathology* / Q000601:surgery*; D016031:Liver Transplantation / Q000502:physiology*; D019520:Living Donors; D016343:Monitoring, Intraoperative; D010949:Plasma; D013916:Thrombelastography