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 27 May 2018

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News

Coagulation defects do not predict transfusions during liver transplant

Coagulation defects do not predict blood product requirements during liver transplantation, finds May's issue of Transplantation.

News image

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The correction of coagulation defects with plasma transfusion does not decrease the need for intraoperative red blood cell transfusions during liver transplantation.

On the contrary, it leads to a hypervolemic state that results in increased blood loss.

The overall 1-year survival rate was 86%
Transplantation

A previous study has shown that plasma transfusion has been associated with a decreased 1-year survival rate.

Dr Luc Massicotte and colleagues conducted a prospective study to evaluate whether anesthesiologists could reduce red blood cell transfusion requirements during liver transplantation by eliminating plasma transfusion.

The team studied 200 consecutive liver transplantations over a 3-year period.

Patients were divided into 2 groups.

Patients in Group 1 had a low starting international normalized ratio value of less than 1.5, and those in Group 2 had a high international normalized ratio over 1.5.

The team maintained low central venous pressure in all patients before the anhepatic phase.

Coagulation parameters were not corrected preoperatively or intraoperatively in the absence of uncontrollable bleeding.

Phlebotomy and auto transfusion of blood salvaged were used following our protocol.

The team analyzed independent variables in both univariate and multivariate fashion to find a link with red blood cell transfusions or decreased survival rate.

The researchers found that the mean number of intraoperative red blood cell units transfused was 0.3.

Plasma, platelet, albumin, and cryoprecipitate were not transfused.

In 82% of the patients, no blood product was used during their transplantation.

The average final hemoglobin value was 91 g/L.

The team found no differences in transfusional rate, final hemoglobin, or bleeding between the 2 groups.

The overall 1-year survival rate was 86%.

Logistic regression showed that avoidance of plasma transfusion, phlebotomy, and starting hemoglobin value were significantly linked to liver transplantation without red blood cell transfusion.

The researchers observed that the need for intraoperative red blood cell transfusion, and Pugh's score were linked to the decreased 1-year survival rate.

Dr Massicotte‘s team concluded, "The avoidance of plasma transfusion was associated with a decrease in red blood cell transfusions during liver transplantation."

"There was no link between coagulation defects and bleeding or red blood cell or plasma transfusions."

"Previous reports indicating that it is neither useful nor necessary to correct coagulation defects with plasma transfusion before liver transplantation seem further corroborated by this study."

"The team believe that this work also supports the practice of lowering central venous pressure with phlebotomy to reduce blood loss, during liver dissection, without any deleterious effect."

Transplant 2008: 85(7): 956-62
21 April 2008

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