Preoperative risk factors for intra-operative bleeding in pediatric liver transplantation.
This study analyzes the preoperative risk factors for intra-operative bleeding in our recent series of pediatric LTs. Between November 2009 and November 2014, 84 consecutive isolated pediatric LTs were performed in 81 children. Potential preoperative predictive factors for bleeding, amount of intra-operative transfusions, postoperative course, and outcome were recorded. Cutoff point for intra-operative HBL was defined as intra-operative RBC transfusions ≥1 TBV. Twenty-six patients (31%) had intra-operative HBL. One-year patient survival after LT was 66.7% (CI 95%=[50.2-88.5]) in HBL patients and 83.8% (CI 95%=[74.6-94.1]) in the others (P=.054). Among 13 potential preoperative risk factors, three of them were identified as independent predictors of high intra-operative bleeding: abdominal surgical procedure(s) prior to LT, factor V level ≤30% before transplantation, and ex situ parenchymal transsection of the liver graft. Based on these findings, we propose a simple score to predict the individual hemorrhagic risk related to each patient and graft association. This score may help to better anticipate intra-operative bleeding and improve patient's management.
Pediatric surgery unit, Hôpital Necker enfants malades, Paris, France.
Martina
http://orcid.org/0000-0002-2972-4761
M
Fanna
Clinical research unit, Hôpital Necker enfants malades, Paris, France.
Amandine
A
Baptiste
Pediatric surgery unit, Hôpital Necker enfants malades, Paris, France.
Carmen
C
Capito
Anesthesiology unit, Hôpital Necker enfants malades, Paris, France.
Rocio
R
Ortego
Anesthesiology unit, Hôpital Necker enfants malades, Paris, France.
Raffaella
R
Pacifico
Intensive care unit, Hôpital Necker enfants malades, Paris, France.
Fabrice
F
Lesage
Intensive care unit, Hôpital Necker enfants malades, Paris, France.
Florence
F
Moulin
Hepatology unit, Hôpital Necker enfants malades, Paris, France.
Dominique
D
Debray
Hepatology unit, Hôpital Necker enfants malades, Paris, France.
Samira
S
Sissaoui
Hepatology unit, Hôpital Necker enfants malades, Paris, France.
Muriel
M
Girard
Hepatology unit, Hôpital Necker enfants malades, Paris, France.
Florence
F
Lacaille
Anesthesiology unit, Hôpital Necker enfants malades, Paris, France.
Caroline
C
Telion
Clinical research unit, Hôpital Necker enfants malades, Paris, France.
Caroline
C
Elie
Pediatric surgery unit, Hôpital Necker enfants malades, Paris, France.
Yves
Y
Aigrain
Pediatric surgery unit, Hôpital Necker enfants malades, Paris, France.
Christophe
C
Chardot
D000293:Adolescent; D019540:Area Under Curve; D001803:Blood Transfusion; D002648:Child; D002675:Child, Preschool; D004912:Erythrocytes / Q000166:cytology; D005260:Female; D006801:Humans; D007223:Infant; D007432:Intraoperative Period; D017093:Liver Failure / Q000601:surgery*; D016031:Liver Transplantation; D019520:Living Donors; D008297:Male; D019106:Postoperative Hemorrhage / Q000209:etiology* / Q000517:prevention & control; D011184:Postoperative Period; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors; D014019:Tissue Donors; D016896:Treatment Outcome
hemorrhage; pediatric liver transplantation; predictive factors; surgery; transfusion