title: Predictors of blood product use in orthotopic liver transplantation using the piggyback hepatectomy technique.
abstract: Orthotopic liver transplantation (OLT) has historically been associated with massive blood loss and hemodynamic instability related to the coexistence of varices, coagulopathy, thrombocytopenia, and portal hypertension. Piggyback hepatectomy (PGB) is a technique increasingly utilized in OLT to avoid veno-venous bypass and vena cava clamping. This study evaluated the factors associated with blood loss and blood product requirement in PGB.
  
  
  METHODS
  This study is a retrospective review of the anesthesia preoperative and operative notes and computerized lab values for all adult cadaveric liver transplants over a 42-month period. These data were combined with the liver transplant database for analysis. Approximately 98% of the transplants were performed using a standard piggyback approach with no use of veno-venous bypass.
  
  
  RESULTS
  Data were included for all 526 transplants performed during this time period. Estimated blood loss (EBL) was 1000 cc. Median transfusion requirement was 3 units packed red blood cells, 7 units fresh frozen plasma, and 6 units platelets. Multivariate linear regression demonstrated that predictors of EBL were age, MELD score, preoperative hemoglobin, initial fibrinogen, initial central venous pressure, and total anesthesia time. Predictors of PRBC useage were age, MELD score, preoperative hemoglobin, initial fibrinogen, and anesthesia time. Postoperatively increased transfusion requirement was associated with increased length of hospital stay and lower 90-day and 1-year graft and patient survivals.
  
  
  CONCLUSIONS
  These results demonstrate that PGB can be safely accomplished in nearly all liver transplant patients without venovenous bypass or vena cava clamping and with less warm ischemia, which may ultimately be associated with less perioperative morbidity and improved outcomes.
authors: Department of Surgery, Transplantation Section, Indiana University School of Medicine, Indianapolis, Indiana 46202-5250, USA. mangus@iupui.edu
authors: R S
authors: RS
authors: Mangus
authors: S B
authors: SB
authors: Kinsella
authors: M M
authors: MM
authors: Nobari
authors: J A
authors: JA
authors: Fridell
authors: R M
authors: RM
authors: Vianna
authors: E S
authors: ES
authors: Ward
authors: R
authors: R
authors: Nobari
authors: A J
authors: AJ
authors: Tector
mesh_terms: D000328:Adult; D016913:Blood Component Transfusion / Q000706:statistics & numerical data*; D016063:Blood Loss, Surgical / Q000517:prevention & control; D002102:Cadaver; D017707:Erythrocyte Transfusion / Q000706:statistics & numerical data; D005260:Female; D006439:Hemodynamics; D006498:Hepatectomy / Q000379:methods*; D006801:Humans; D007431:Intraoperative Complications / Q000517:prevention & control; D008107:Liver Diseases / Q000145:classification / Q000601:surgery; D016031:Liver Transplantation / Q000379:methods*; D008297:Male; D008875:Middle Aged; D010949:Plasma; D017713:Platelet Transfusion / Q000706:statistics & numerical data; D012189:Retrospective Studies; D014019:Tissue Donors