title: Risk factors for bleeding and transfusion during orthotopic liver transplantation.
abstract: OBJECTIVE
  While orthotopic liver transplantation (OLT) can be associated with haemorrhage, the risk factors for bleeding and transfusion remain difficult to predict. Perioperative transfusion has potentially deleterious side effects and impairs graft and patient survival. Preoperative identification of patients at high risk of bleeding is of clinical interest to manage perioperative transfusion and blood product storage.
  
  
  METHODS
  Retrospective study.
  
  
  METHODS
  All OLT conducted between 2004 and 2008 in the University Hospital of Bordeaux were studied. Risk factors for bleeding greater than one blood volume and for massive red blood cell (RBC) transfusion were determined using univariate and multivariate analysis. Thresholds were determined with ROC curve analysis.
  
  
  RESULTS
  One hundred and forty-eight transplantations were studied. Preoperative haemoglobin and Child class A were independent protective risk factors for bleeding greater than one blood volume (OR 0.81 [0.67-0.98] and 0.27 [0.10-0.72], respectively). Preoperative Hb was a protective risk factor (OR 0.71 [0.58-0.88]) whereas history of oesophageal varicose bleeding was a risk factor (OR 4.67 [1.45-15.05]) for transfusion of more than eight RBC.
  
  
  CONCLUSIONS
  Risk factors for bleeding and transfusion during OLT identified in this study were of little clinical usefulness so blood products should always be available during the procedure.
authors.affiliation: Service d'anesthésie-réanimation 1, CHU de Bordeaux, université Victor-Segalen-Bordeaux 2, 33076 Bordeaux cedex, France. stephanie.roullet@chu-bordeaux.fr
authors.forename: S
authors.initials: S
authors.lastname: Roullet
authors.forename: M
authors.initials: M
authors.lastname: Biais
authors.forename: E
authors.initials: E
authors.lastname: Millas
authors.forename: P
authors.initials: P
authors.lastname: Revel
authors.forename: A
authors.initials: A
authors.lastname: Quinart
authors.forename: F
authors.initials: F
authors.lastname: Sztark
mesh_terms: D000368:Aged; D016063:Blood Loss, Surgical / Q000706:statistics & numerical data*; D001803:Blood Transfusion; D001810:Blood Volume; D017707:Erythrocyte Transfusion / Q000009:adverse effects; D005260:Female; D006452:Hemoglobinometry; D006801:Humans; D007676:Kidney Failure, Chronic / Q000209:etiology / Q000601:surgery; D008111:Liver Function Tests; D016031:Liver Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative; D012372:ROC Curve; D012189:Retrospective Studies; D012307:Risk Factors