title: Transfusion management and immunohematologic complications in liver transplantation: experience of a single institution.
abstract: OBJECTIVE
  Liver transplantation (LT) has traditionally been associated with major blood loss and consequently high blood transfusion requirements. Our objective was to analyze transfusion management and incidence of immunohematologic complications in patients undergoing LT at our institution.
  
  
  METHODS
  A retrospective analysis of immunohematologic events and transfusion outcomes was carried out at La Fe University Hospital in Valencia. Data from 654 patients were reviewed: 654 underwent only one LT while 36 underwent second LT.
  
  
  RESULTS
  Patients received a median of 3 red blood cell (RBC) concentrates, 2 platelets concentrates (PCs) and 2 fresh frozen plasma units (FFPs). Variables significantly influencing RBC transfusions were: the MELD score, hemoglobin levels, and the platelet counts before LT. 27 patients (4.1%) had a positive antibody screening before transplant. Immunohematologic events occurred in 8% of the patients, mostly in the first month after LT, and involved hemolysis in 13 cases. Mortality was significantly higher in patients developing immunohematologic disorders (42.8 vs. 18.3%; p < 0.001). In the multivariable analysis, only ABO minor incompatibility between donor and recipient significantly increased the appearance of immunohematologic incidences (OR 4.92, 95% CI 2.31-10.50; p < 0.001).
  
  
  CONCLUSIONS
  Transfusion management of patients that underwent LT can be complicated by immunohematologic problems. Blood banks should implement the DAT test in each transfusion to detect them.
authors.affiliation: Blood Bank, Hematology Department, Hospital Universitari I Politècnic La Fe. Valencia, Spain.
authors.forename: Pilar
authors.initials: P
authors.lastname: Solves
authors.affiliation: Blood Bank, Hematology Department, Hospital Universitari I Politècnic La Fe. Valencia, Spain.
authors.forename: Nelly
authors.initials: N
authors.lastname: Carpio
authors.affiliation: Blood Bank, Hematology Department, Hospital Universitari I Politècnic La Fe. Valencia, Spain.
authors.forename: Federico
authors.initials: F
authors.lastname: Moscardo
authors.affiliation: Blood Bank, Hematology Department, Hospital Universitari I Politècnic La Fe. Valencia, Spain.
authors.forename: Aima
authors.initials: A
authors.lastname: Lancharro
authors.affiliation: Blood Bank, Hematology Department, Hospital Universitari I Politècnic La Fe. Valencia, Spain.
authors.forename: Isabel
authors.initials: I
authors.lastname: Cano
authors.affiliation: Liver Transplant Unit, Hospital Universitari I Politècnic La Fe, Valencia, Spain.
authors.forename: Angel
authors.initials: A
authors.lastname: Moya
authors.affiliation: Liver Transplant Unit, Hospital Universitari I Politècnic La Fe, Valencia, Spain.
authors.forename: Rafael
authors.initials: R
authors.lastname: López-Andujar
authors.affiliation: Blood Bank, Hematology Department, Hospital Universitari I Politècnic La Fe. Valencia, Spain.
authors.forename: Miguel Ángel
authors.initials: MÁ
authors.lastname: Sanz
keywords: Blood transfusion; Hemolysis; Immunohematologic event; Liver transplantation; Transfusion alloimmunization