Balanced Blood Product Transfusion during Adult Liver Transplantation

Orthotopic liver transplant (LT) is often associated with massive blood loss and significant transfusion requirements. Recent recommendations for resuscitation strategy in bleeding patients include transfusion of balanced blood products, fresh frozen plasma (FFP), platelets, red blood cells (PRBC), and restricted use of crystalloids.

To evaluate whether the intraoperative transfusion ratio of fresh frozen plasma to packed red blood cells units (FFP: PRBC ≤1:1 versus >1:1) plays a positive role in reducing PRBC transfusion in LT.

This is a retrospective study of 84 liver transplant recipients who received at least one PRBC unit during the surgery. The patients were grouped: into those who received intraoperative FFP: PRBC ratio ≤ 1:1 (low) versus the ratio > 1:1 (high). Selected perioperative variables were compared between the two groups. The variables included; baseline characteristics of the patients, intraoperative transfused PRBC and blood products, postoperative mean hemoglobin, platelets, international normalized ratio, postoperative transfused PRBC and blood component, early postoperative complications as re-operation due to bleeding, portal vein thrombosis, and duration of stay in the intensive care unit.

There was a significant difference between the two groups in preoperative BMI (P = 0.04) and hemoglobin (P = 0.005), and the two variables were higher in the high-ratio group. Patients in the ≤1: 1 group versus >1:1 had lower intraoperative requirements for PRBC (P<0.001). Importantly, the postoperative mean PRBC transfused units in the high ratio group were 1.76 times that of the low ratio group (incidence rate ratio [IRR], 1.76; 95% CI, 1.07 –2.90).

In patients undergoing LT, intraoperative plasma transfusion with a PRBC ratio of ≤1:1 was associated with a reduced need for PRBC transfusion.