Effects of intraoperative blood transfusion on postoperative complications and survival after orthotopic liver transplantation.

BACKGROUND/AIMS: Massive blood transfusion related to the coagulation disorders occurring during the anhepatic and reperfusion phases, remains a serious problem during orthotopic liver transplantation. To analyze the influence of intraoperative blood transfusion on postoperative complications, and survival and to identify the preoperative variables associated with greater intraoperative bleeding, 100 orthotopic liver transplantations, carried out on adults, were reviewed in our center.

METHODOLOGY: Patients were grouped into three categories according to intraoperative blood volume transfused; group A, 1.5 or less blood volumes transfused; group B, > 1.5 and < 3 volumes used and group C, 3 or more volumes given.

RESULTS: Group C patients had a higher incidence of upper abdominal surgery (p < 0.01 between groups C and A. and p<0.05 between groups C and B); higher values of postoperative total bilirubin and SGOT, and lower prothrombin activity. Acute rejection and steroid-resistant episodes per patient occurred less commonly (p <0.01 between groups C and A) and so did chronic rejection (p <0.05 between groups C and B). Higher infection rate, and gastrointestinal and intraabdominal complication rates were also noticed in groups C and B (p < 0.01 and p < 0.05 respectively). Patient survival rates were lower in group C (p < 0.05 between groups C and A).

CONCLUSIONS: It was concluded that previous upper abdominal surgery was the only preoperative factor associated with massive blood transfusion. Poor graft function during the first days after transplant, higher incidence of infections, higher incidence of gastrointestinal and intraabdominal complications, and lower rejection episodes and survival for patients receiving intraoperatively large amounts of blood can be expected.