title: Risk factors and outcomes of massive red blood cell transfusion following living donor liver transplantation.
abstract: OBJECTIVE
  To identify the factors influencing blood loss and secondary blood transfusion and to investigate the outcomes of patients who underwent a massive blood transfusion (MBT) following living donor liver transplantation (LDLT).
  
  
  METHODS
  Patients who underwent primary adult-to-adult right hepatic lobe LDLT were included in the study, and were divided into the MBT group [≥6 red blood cell (RBC) units in 24 h] and the non-massive blood transfusion (NMBT) group (<6 RBC units in 24 h). All potential risk factors, length of intensive care unit (ICU) stay and long-term survival rate of the patients in the two groups were analyzed.
  
  
  RESULTS
  The data of 181 eligible patients were retrospectively analyzed. A decreased long-term survival rate, a higher incidence of postoperative infection and prolonged ICU stay were observed in the MBT group. No significant difference was observed in survival rate between patients having platelet transfusion>2 units and ≤2 units. Hemoglobin<100 g/L, platelet counts<70×10(9)/L, fibrinogen level<1.5 g/L and history of upper abdominal surgery were found to be independent risk factors.
  
  
  CONCLUSIONS
  Blood transfusion during LDLT can be predicted using preoperative variables. Massive RBC transfusion may lead to poor long-term survival, higher postoperative infection rate and prolonged ICU stay. Platelet transfusion may not be a risk factor for long-term survival.
authors.affiliation: Department of Liver and Vascular Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China.
authors.forename: Chuan
authors.initials: C
authors.lastname: Li
authors.affiliation: Department of Liver and Vascular Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China.
authors.forename: Kai
authors.initials: K
authors.lastname: Mi
authors.affiliation: Department of Liver and Vascular Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China.
authors.forename: Tian Fu
authors.initials: TF
authors.lastname: Wen
authors.affiliation: Department of Liver and Vascular Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China.
authors.forename: Lu Nan
authors.initials: LN
authors.lastname: Yan
authors.affiliation: Department of Liver and Vascular Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China.
authors.forename: Bo
authors.initials: B
authors.lastname: Li
authors.affiliation: Department of Liver and Vascular Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China.
authors.forename: Yong Gang
authors.initials: YG
authors.lastname: Wei
authors.affiliation: Department of Liver and Vascular Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China.
authors.forename: Jia Ying
authors.initials: JY
authors.lastname: Yang
authors.affiliation: Department of Liver and Vascular Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China.
authors.forename: Ming Qing
authors.initials: MQ
authors.lastname: Xu
authors.affiliation: Department of Liver and Vascular Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China.
authors.forename: Wen Tao
authors.initials: WT
authors.lastname: Wang
mesh_terms: D000005:Abdomen / Q000601:surgery; D000328:Adult; D016063:Blood Loss, Surgical; D001810:Blood Volume; D016009:Chi-Square Distribution; D003422:Critical Care; D017707:Erythrocyte Transfusion; D005340:Fibrinogen / Q000378:metabolism; D006454:Hemoglobins / Q000378:metabolism; D006801:Humans; D053208:Kaplan-Meier Estimate; D007902:Length of Stay; D008107:Liver Diseases / Q000601:surgery*; D016031:Liver Transplantation / Q000009:adverse effects*; D016015:Logistic Models; D015999:Multivariate Analysis; D010976:Platelet Count; D012189:Retrospective Studies; D012307:Risk Factors; D013530:Surgical Wound Infection / Q000209:etiology
chemical_list: D006454:Hemoglobins; D005340:Fibrinogen