title: Preoperative variables associated with transfusion requirements in orthotopic liver transplantation.
abstract: BACKGROUND
  Patients with end-stage chronic liver disease (CLD) and submitted to orthotopic liver transplantation (OLT) usually require blood transfusion during the procedure or in the post-operative period due to hemorrhage. Risk factors for transfusion need are not fully known. This study aimed to identify the factors associated with blood components requirements.
  
  
  METHODS
  In this retrospective study a total of 166 consecutive patients submitted to OLT with the piggyback technique, between 2001 and 2011, were evaluated for number of blood components transfused during surgical procedure and the four subsequent days (total of 5 days). We evaluated the association between the number of units transfused and clinical variables, such as: Child-Turcotte-Pugh (CTP) and MELD scores, hemoglobin concentration (Hb), INR, serum creatinine, bilirubin and albumin concentrations, and total, hypothermic and normothermic time of graft ischemia.
  
  
  RESULTS
  152 (91.6%) Patients were transfused (median of 24 units of blood components). Risk factors for higher blood transfusion requirements were CTP, INR, Hb and total time of graft ischemia. The group with CTP-A score received less blood components than CTP-B/C (11.5 vs 27; P=0.002). The group with Hb<10 required a higher number of blood units (34.5 vs 23; P=0.003). The group with INR<1.5 received less blood units (20.5 vs 31; P=0.012). The group transplanted with a graft exposed to less than the median of 555 min of ischemia received less transfusion (21 vs 27; P=0.03). MELD score and the other factors were not associated with blood requirements.
  
  
  CONCLUSIONS
  These results demonstrate that CTP, but not MELD score, hemoglobin concentration, INR, and total time of graft ischemia are preoperative variables associated with blood requirements during OLT and in the subsequent days.
authors.affiliation: Center for Cell-Based Therapy, Medical School of Ribeirão Preto, University of São Paulo, Brazil. Electronic address: gil@hemocentro.fmrp.usp.br.
authors.forename: Gil Cunha
authors.initials: GC
authors.lastname: De Santis
authors.affiliation: Center for Cell-Based Therapy, Medical School of Ribeirão Preto, University of São Paulo, Brazil.
authors.forename: Denise Menezes
authors.initials: DM
authors.lastname: Brunetta
authors.affiliation: Center for Cell-Based Therapy, Medical School of Ribeirão Preto, University of São Paulo, Brazil.
authors.forename: Mirella
authors.initials: M
authors.lastname: Nardo
authors.affiliation: Center for Cell-Based Therapy, Medical School of Ribeirão Preto, University of São Paulo, Brazil.
authors.forename: Luciana Correa
authors.initials: LC
authors.lastname: Oliveira
authors.affiliation: Digestive Surgery Division, Department of Surgery and Anatomy, Medical School of Ribeirão Preto, University of São Paulo, Brazil.
authors.forename: Fernanda Fernandes
authors.initials: FF
authors.lastname: Souza
authors.affiliation: Digestive Surgery Division, Department of Surgery and Anatomy, Medical School of Ribeirão Preto, University of São Paulo, Brazil.
authors.forename: Daniel
authors.initials: D
authors.lastname: Cagnolati
authors.affiliation: Digestive Surgery Division, Department of Surgery and Anatomy, Medical School of Ribeirão Preto, University of São Paulo, Brazil.
authors.forename: Ênio David
authors.initials: ÊD
authors.lastname: Mente
authors.affiliation: Digestive Surgery Division, Department of Surgery and Anatomy, Medical School of Ribeirão Preto, University of São Paulo, Brazil.
authors.forename: Ajith Kumar
authors.initials: AK
authors.lastname: Sankarankutty
authors.affiliation: Center for Cell-Based Therapy, Medical School of Ribeirão Preto, University of São Paulo, Brazil; Hematology Division, Department of Internal Medicine, Medical School of Ribeirão Preto, University of São Paulo, Brazil.
authors.forename: Dimas Tadeu
authors.initials: DT
authors.lastname: Covas
authors.affiliation: Digestive Surgery Division, Department of Surgery and Anatomy, Medical School of Ribeirão Preto, University of São Paulo, Brazil.
authors.forename: Orlando
authors.initials: O
authors.lastname: de Castro e Silva
mesh_terms: D000368:Aged; D016913:Blood Component Transfusion / Q000379:methods*; D016063:Blood Loss, Surgical; D001803:Blood Transfusion / Q000379:methods*; D058625:End Stage Liver Disease / Q000097:blood / Q000628:therapy*; D005260:Female; D006454:Hemoglobins / Q000032:analysis; D006470:Hemorrhage / Q000628:therapy; D006526:Hepatitis C / Q000097:blood; D006801:Humans; D019934:International Normalized Ratio; D007511:Ischemia; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010314:Partial Thromboplastin Time; D010976:Platelet Count; D057234:Preoperative Period; D012189:Retrospective Studies; D012307:Risk Factors
chemical_list: D006454:Hemoglobins
keywords: Blood transfusion; Liver transplantation; Predictors