title: Transfusion rate for 500 consecutive liver transplantations: experience of one liver transplantation center.
abstract: BACKGROUND
  Orthotopic liver transplantation (OLT) has been associated with major blood loss and the need for blood product transfusions. During the last decade, improved surgical and anesthetic management has reduced intraoperative blood loss and blood product transfusions. A first report from our group published in 2005 described a mean intraoperative transfusion rate of 0.3 red blood cell (RBC) unit per patient for 61 consecutive OLTs. Of these patients, 80.3% did not receive any blood product. The interventions leading to those results were a combination of fluid restriction, phlebotomy, liberal use of vasopressor medications, and avoidance of preemptive transfusions of fresh frozen plasma. This is a follow-up observational study, covering 500 consecutive OLTs.
  
  
  METHODS
  Five hundred consecutive OLTs were studied. The transfusion rate of the first 61 OLTs was compared with the last 439 OLTs. Furthermore, multivariate logistic regression was used to determine the main predictors of intraoperative blood transfusion.
  
  
  RESULTS
  A mean (SD) of 0.5 (1.3) RBC unit was transfused per patient for the 500 OLTs, and 79.6% of them did not receive any blood product. There was no intergroup difference except for the final hemoglobin (Hb) value, which was higher for the last 439 OLTs compared with the previously reported smaller study (94 [20] vs. 87 [20] g/L). Two variables, starting Hb value and phlebotomy, correlated with OLT without transfusion.
  
  
  CONCLUSIONS
  In our center, a low intraoperative transfusion rate could be maintained throughout 500 consecutive OLTs. Bleeding did not correlate with the severity of recipient's disease. The starting Hb value showed the strongest correlation with OLT without RBC transfusion.
authors.affiliation: Department of Anesthesiology, Centre Hôspitalier de l'Université de Montréal - Hôpital Saint-Luc, Montreal, Canada.
authors.forename: Luc
authors.initials: L
authors.lastname: Massicotte
authors.forename: André Y
authors.initials: AY
authors.lastname: Denault
authors.forename: Danielle
authors.initials: D
authors.lastname: Beaulieu
authors.forename: Lynda
authors.initials: L
authors.lastname: Thibeault
authors.forename: Zoltan
authors.initials: Z
authors.lastname: Hevesi
authors.forename: Anna
authors.initials: A
authors.lastname: Nozza
authors.forename: Réal
authors.initials: R
authors.lastname: Lapointe
authors.forename: André
authors.initials: A
authors.lastname: Roy
mesh_terms: D000328:Adult; D000368:Aged; D016913:Blood Component Transfusion / Q000401:mortality*; D016063:Blood Loss, Surgical / Q000401:mortality*; D017707:Erythrocyte Transfusion / Q000401:mortality*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016031:Liver Transplantation / Q000401:mortality*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D015999:Multivariate Analysis; D010949:Plasma; D012189:Retrospective Studies