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Published on: May 7, 2015
Decreasing blood product requirements after orthotopic liver transplantation
P C Gordon1, M F M James, C W Spearman
1Departments of Anaesthesia, Surgery and Medicine, University of Cape Town and Groote Schuur Hospital, and Medical Research Council Liver Research Centre, Cape Town.
Insights
Transfusion requirements for liver transplants decreased significantly over 13 years due to increased experience and improved monitoring. Orthotopic liver transplantation (OLT) is no longer considered wasteful of blood resources.
Area of Science:
- Hepatology
- Transfusion Medicine
- Surgical Outcomes
Background:
- Orthotopic liver transplantation (OLT) is a complex procedure often associated with substantial blood product usage.
- Monitoring transfusion requirements is crucial for optimizing patient care and resource management in OLT programs.
Purpose of the Study:
- To analyze the trends in blood product transfusion needs during the initial 50 orthotopic liver transplantation (OLT) surgeries at Groote Schuur Hospital.
- To identify factors contributing to changes in transfusion requirements over time.
Main Methods:
- A retrospective analysis of blood product usage in the first 50 OLT operations.
- Patients were chronologically divided into three groups to compare transfusion requirements.
- Quantification of packed red cells, fresh frozen plasma (FFP), platelets, and cryoprecipitate transfused intraoperatively.
Main Results:
- A significant reduction in intraoperative transfusions of packed red cells, FFP, and platelets was observed over the study period.
- Median packed red cell units decreased from 13.5 to 5.0, and platelet transfusions dropped to zero in later patients.
- The average cost of intraoperative blood products per patient decreased substantially, from R13,034 to R7,396.
Conclusions:
- Blood product transfusion requirements during OLT have decreased significantly with program maturation.
- Increased surgical experience, use of aprotinin, and thromboelastogram monitoring contributed to reduced transfusion needs.
- OLT can be performed efficiently, without being considered wasteful of blood resources, and platelet use can be guided by specific indications.
Objectives:
To document the changing blood product transfusion requirements over time during the first 50 orthotopic liver transplantation (OLT) operations performed at Groote Schuur Hospital.
Design:
The first 50 OLT operations were divided into three groups chronologically and blood transfusion requirements were compared across the three groups.
Setting:
Groote Schuur Hospital, Cape Town.
Subjects:
Forty-seven patients undergoing 50 OLT operations between October 1988 and September 1999. The majority of patients had end-stage chronic liver disease. Patients were divided chronologically into three groups of 16, 17 and 17 patients.
Outcome Measures:
The number of units of blood products transfused in each group was quantified.
Results:
During the study period there was a significant decrease in the number of units of packed red cells, fresh frozen plasma (FFP) and platelets (but not cryoprecipitate) transfused intraoperatively. The median number of units of packed cells decreased from 13.5 in our first 16 patients (group 1) to 5.0 in our last 17 (group 3). The median number of units of platelets transfused was 9 in group 1 and 0 in groups 2 and 3. No platelets were transfused in our last 22 patients. The average cost of blood products transfused intraoperatively per patient in the three groups decreased from R13 034 in group 1 to R11 389 in group 2 to R7 396 in group 3.
Conclusion:
The number of units of blood products transfused during OLT operations has decreased since the programme started 13 years ago. The reasons include increased experience, the use of aprotinin to block fibrinolysis and the selective use of the thromboelastogram to monitor coagulation intraoperatively. OLT need no longer be regarded as wasteful of blood resources. Use of platelets to treat thrombocytopenia need not be empirical.
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