title: Clinical Practice of Blood Transfusion in Orthotopic Organ Transplantation: A Single Institution Experience.
abstract: BACKGROUND
  Orthotopic organ transplantation, a treatment option for irreversible organ dysfunction according to organ failure, severe damaged organ or malignancy in situ, was usually accompanied with massive blood loss thus transfusion was required. We aimed to evaluate the adverse impact of blood transfusion on solid organ transplantation.
  
  
  METHODS
  From January, 2009 to December, 2014, patients who received orthotopic organ transplantation at Far Eastern Memorial Hospital medical center were enrolled. Clinical data regarding anemia status and red blood cell (RBC) transfusion before, during and after operation, as well as patient outcomes were collected for further univariate analysis.
  
  
  RESULTS
  A total of 105 patients who underwent orthotopic transplantation, including liver, kidney and small intestine were registered. The mean hemoglobin (Hb) level upon admission and before operation were 11.6 ± 1.8 g/dL and 11.7 ± 1.7 g/dL, respectively; and the nadir Hb level post operation and the final Hb level before discharge were 8.3 ± 1.6 g/dL and 10.2 ± 1.6 g/dL, respectively. The median units (interquartile range) of RBC transfusion in pre-operative, peri-operative and post-operative periods were 0 (0-0), 2 (0-12), and 2 (0-6) units, respectively. Furthermore, the median (interquartile range) length of hospital stay (LHS) from admission to discharge and from operation to discharge were 28 (17-44) and 24 (16-37) days, respectively. Both peri-operative and post-operative RBC transfusion were associated with longer LHS from admission to discharge and from operation to discharge. Furthermore, it increased the risk of post-operative septicemia. While peri-operative RBC transfusion elevated the risk of acute graft rejection in patients who received orthotopic transplantation.
  
  
  CONCLUSIONS
  Worse outcome could be anticipated in those who had received massive RBC transfusion in transplantation operation. Hence, peri-operative RBC transfusion should be avoided as much as possible.
authors.affiliation: Department of Surgery, Far Eastern Memorial Hospital, Taipei City, Taiwan E-mail : ychen@mail.femh.org.tw.
authors.forename: Huang-Wen
authors.initials: HW
authors.lastname: Tsai
authors.forename: Fu-Chien
authors.initials: FC
authors.lastname: Hsieh
authors.forename: Chih-Chun
authors.initials: CC
authors.lastname: Chang
authors.forename: Ming-Jang
authors.initials: MJ
authors.lastname: Su
authors.forename: Fang-Yeh
authors.initials: FY
authors.lastname: Chu
authors.forename: Kuo-Hsin
authors.initials: KH
authors.lastname: Chen
authors.forename: Kuo-Shyang
authors.initials: KS
authors.lastname: Jeng
authors.forename: Yun
authors.initials: Y
authors.lastname: Chen
mesh_terms: D000328:Adult; D000740:Anemia / Q000628:therapy; D016063:Blood Loss, Surgical; D005260:Female; D006268:Health Facilities; D006801:Humans; D007421:Intestine, Small / Q000637:transplantation*; D016030:Kidney Transplantation / Q000379:methods*; D007902:Length of Stay; D016031:Liver Transplantation / Q000379:methods*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D065227:Transfusion Reaction; D016896:Treatment Outcome