The impact of intraoperative transfusion of platelets and red blood cells on survival after liver transplantation.
BACKGROUND
Intraoperative transfusion of red blood cells (RBC) is associated with adverse outcome after orthotopic liver transplantation (OLT). Although experimental studies have shown that platelets contribute to reperfusion injury of the liver, the influence of allogeneic platelet transfusion on outcome has not been studied in detail. In this study, we evaluate the impact of various blood products on outcome after OLT.


METHODS
Twenty-nine variables, including blood product transfusions, were studied in relation to outcome in 433 adult patients undergoing a first OLT between 1989 and 2004. Data were analyzed using uni- and multivariate stepwise Cox's proportional hazards analyses, as well as propensity score-adjusted analyses for platelet transfusion to control for selection bias in the use of blood products.


RESULTS
The proportion of patients receiving transfusion of any blood component decreased from 100% in the period 1989-1996 to 74% in the period 1997-2004. In uni- and multivariate analyses, the indication for transplantation, transfusion of platelets and RBC were highly dominant in predicting 1-yr patient survival. These risk factors were independent from well-accepted indices of disease, such as the Model for End-Stage Liver Disease score and Karnofsky score. The effect on 1-yr survival was dose-related with a hazard ratio of 1.377 per unit of platelets (P = 0.01) and 1.057 per unit of RBC (P = 0.001). The negative impact of platelet transfusion on survival was confirmed by propensity-adjusted analysis.


CONCLUSIONS
This retrospective study indicates that, in addition to RBC, platelet transfusions are an independent risk factor for survival after OLT. These findings have important implications for transfusion practice in liver transplant recipients.
de Boer
Marieke T
MT
Department of Surgery, Section of Hepatobiliary Surgery and Liver Transplantation, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
Christensen
Michael C
MC
Asmussen
Mikael
M
van der Hilst
Christian S
CS
Hendriks
Herman G D
HG
Slooff
Maarten J H
MJ
Porte
Robert J
RJ
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016063:Blood Loss, Surgical / Q000517:prevention & control*; D017707:Erythrocyte Transfusion / Q000009:adverse effects*; D005260:Female; D005500:Follow-Up Studies; D006085:Graft Survival; D006801:Humans; D007430:Intraoperative Care; D053208:Kaplan-Meier Estimate; D008107:Liver Diseases / Q000401:mortality* / Q000601:surgery*; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D017713:Platelet Transfusion / Q000009:adverse effects*; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome