title: Predictive factors associated with re-exploration for hemostasis in living donor liver transplantation.
abstract: BACKGROUND
  After liver transplantation (LT), re-exploration of the abdomen to check for bleeding is sometime required. Our study aimed to identify the predictive factors by analysis of preoperative and intraoperative presentations that may impact the re-exploration for hemostasis.
  
  
  METHODS
  We selected 522 consecutive recipients from the Liver Transplant Program database and medical records between January 1, 1994 and December 1, 2009 in our hospital. Demographic data (age, sex, body mass index, weight, MELD score), preoperative laboratory tests (Hb, platelet, albumin, bilirubin, INR, APTT), and intraoperative presentations (ascites and blood loss, crystalloids, 5% albumin infused, blood products used (such as LPRBC, RBC, FFP, platelet, cryoprecipitate), urine output, Hb at end of operation, and anesthesia) were collected for primary comparison. Potential predictors found by univariate comparison at p<0.1 were put into a multiple binary logistic regression model.
  
  
  RESULTS
  Thirty-eight (7.3%) recipients required re-exploration for hemostasis after LDLT; 80% needed re-exploration only once. In univariate analysis, recipients transfused with FFP >10 ml/kg had a 4.2-fold increased risk of re-exploration (p<0.001). Thirteen potential predictors by univariate comparison at p<0.1 were selected into a multiple binary logistic regression. Fresh frozen plasma (FFP) transfused was the sole predictor.
  
  
  CONCLUSIONS
  Each elevation of 1ml of transfused FFP per kg is associated with a 1.033-fold increased incidence of re-exploration for hemostasis. Patients transfused with more than 10 ml/kg FFP during LT require more intensive management within 72 hours due to increase risk of postoperative bleeding.
authors.affiliation: Department of Anesthesiology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, No. 123 Dapi Road, Niaosong, Kaohsiung, Taiwan.
authors.forename: Shao-Chun
authors.initials: SC
authors.lastname: Wu
authors.forename: Chao-Long
authors.initials: CL
authors.lastname: Chen
authors.forename: Chih-Hsien
authors.initials: CH
authors.lastname: Wang
authors.forename: Chia-Jung
authors.initials: CJ
authors.lastname: Huang
authors.forename: Kwok-Wai
authors.initials: KW
authors.lastname: Cheng
authors.forename: Tsung-Hsiao
authors.initials: TH
authors.lastname: Shih
authors.forename: Johnson Chia-Shen
authors.initials: JC
authors.lastname: Yang
authors.forename: Bruno
authors.initials: B
authors.lastname: Jawan
mesh_terms: D000293:Adolescent; D000328:Adult; D016063:Blood Loss, Surgical; D001803:Blood Transfusion / Q000379:methods / Q000592:standards / Q000706:statistics & numerical data; D002648:Child; D002675:Child, Preschool; D005260:Female; D006488:Hemostasis, Surgical / Q000706:statistics & numerical data; D006801:Humans; D016031:Liver Transplantation / Q000379:methods* / Q000592:standards; D019520:Living Donors; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D019990:Perioperative Care / Q000379:methods / Q000592:standards / Q000706:statistics & numerical data; D010949:Plasma; D019106:Postoperative Hemorrhage / Q000209:etiology* / Q000601:surgery; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors; D055815:Young Adult