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Institutional variability in transfusion practice for liver transplantation.
Yves Ozier1, Fabienne Pessione, Emmanuel Samain
1*Department of Anesthesiology, Hôpital Cochin (AP-HP), Université René Descartes, Paris, France; †Etablissement Français des Greffes, Paris, France; ‡Department of Anesthesiology, Hôpital Beaujon (AP-HP), Clichy, France; §Etablissement Français du Sang, Paris, France.
Anesthesia and Analgesia
|August 23, 2003
Summary
Institutional variability in blood product transfusion during liver transplants (OLT) is significant. This study highlights the need to reassess rational blood product use in OLT to reduce unnecessary transfusions.
Area of Science:
- Transplantation Medicine
- Hepatology
- Anesthesiology
Background:
- Orthotopic liver transplantation (OLT) involves significant blood loss, necessitating transfusion therapy.
- Variability in blood product transfusion practices exists across institutions.
Purpose of the Study:
- To evaluate institutional variability in perioperative transfusion therapy for adult OLT.
- To identify factors influencing blood product use and assess the impact of hemoglobin loss on transfusion decisions.
Main Methods:
- Prospective study of 301 adult OLTs across 8 centers over 12 months.
- Multivariate analysis using mixed-effects logistic regression, including factors predisposing to blood loss and center-specific effects.
- Exploration of perioperative hemoglobin loss's influence on red blood cell (RBC), fresh frozen plasma (FFP), and platelet transfusion probabilities.
Main Results:
- Significant inter-center differences were observed in the proportion of patients receiving transfusions exceeding median values for RBCs, FFP, and platelets.
- These differences persisted after adjusting for factors associated with high blood component use and perioperative hemoglobin loss.
- Inter-center variability in RBC use was eliminated only after adjusting for postoperative hemoglobin concentration.
Conclusions:
- Significant heterogeneity in transfusion practices exists among institutions performing OLT.
- Reassessment of the rational use of blood products in OLT is warranted to standardize care and optimize outcomes.