title: Duration of red blood cell storage and outcomes following orthotopic liver transplantation.
abstract: Liver transplantation may be complicated by massive intraoperative bleeding, and red blood cell (RBC) transfusions may be required. The storage duration or age of transfused RBCs has been shown to affect the morbidity and mortality of critically ill, trauma, and cardiac surgery patients. Here we investigate the effect of RBC age on the outcomes of liver transplant patients. Five hundred thirty-one patients underwent orthotopic liver transplantation between January 1, 2000 and August 15, 2010. The patient demographics, the Model for End-Stage Liver Disease-sodium (MELD-Na) score, and the number and age of RBC units were evaluated with univariate and multivariate models of outcomes, which included mortality rates 2 years after transplantation, postoperative infections, and organ rejection. In a univariate analysis, the number of RBC units (but not the RBC age) was associated with increased 2-year mortality, an increased risk of infection, and a decreased risk of organ rejection. Only the number of RBC units was associated with increased 2-year mortality in a multivariate Cox regression model. The mortality risk was decreased by two-thirds for patients who received <10 U of RBCs versus those who received ≥10 U (hazard ratio = 0.33, 95% confidence interval = 0.16-0.69, P = 0.003). The number of transfused RBC units was not associated with the risk of infection or organ rejection in a multivariate logistic regression model. In conclusion, the RBC age is not associated with infection, organ rejection, or death in liver transplant patients. Patients who receive more blood have an increased risk of death. In a multivariate model, the MELD-Na score was not associated with increased mortality, and this is consistent with previous studies demonstrating that the MELD-Na score is a poor predictor of long-term survival after transplantation.
authors.affiliation: Departments of Anesthesiology, University of Virginia Health System, Charlottesville, VA 22908, USA.
authors.forename: Lauren K
authors.initials: LK
authors.lastname: Dunn
authors.forename: Robert H
authors.initials: RH
authors.lastname: Thiele
authors.forename: Jennie Z
authors.initials: JZ
authors.lastname: Ma
authors.forename: Robert G
authors.initials: RG
authors.lastname: Sawyer
authors.forename: Edward C
authors.initials: EC
authors.lastname: Nemergut
mesh_terms: D016063:Blood Loss, Surgical / Q000401:mortality / Q000517:prevention & control*; D001793:Blood Preservation / Q000009:adverse effects / Q000379:methods / Q000401:mortality; D016009:Chi-Square Distribution; D003141:Communicable Diseases / Q000209:etiology; D017707:Erythrocyte Transfusion; D005260:Female; D006084:Graft Rejection / Q000209:etiology; D006801:Humans; D053208:Kaplan-Meier Estimate; D016031:Liver Transplantation / Q000009:adverse effects* / Q000401:mortality; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016016:Proportional Hazards Models; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D014768:Virginia