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Hemoderivative Transfusion in Liver Transplantation: Comparison Between Recipients of Grafts From Brain Death Donors
Iago Justo1, Alberto Marcacuzco1, Oscar Caso1
1Unit of HPB Surgery and Abdominal Organ Transplantation, Department of General Surgery, "Doce de Octubre" University Hospital, Instituto de Investigación (Imas12), Faculty of Medicine, Complutense University, Madrid, Spain.
Insights
Liver transplantation using grafts from donors after circulatory death (DCD) requires more blood transfusions than those from brain-dead donors. This highlights the need for careful management of DCD liver grafts to optimize patient outcomes.
Area of Science:
- Transplantation immunology
- Hepatobiliary surgery
- Organ donation and procurement
Background:
- Intraoperative bleeding during liver transplantation is linked to increased morbidity, mortality, and reduced patient/graft survival.
- Optimizing graft utilization is crucial for improving liver transplant outcomes.
- Understanding differences between donor types can inform surgical strategies.
Purpose of the Study:
- To compare the outcomes of liver transplantation using grafts from donors after circulatory death (DCD) versus donors after brain death (DBD).
- To investigate the association between graft type and the requirement for blood product transfusion.
- To identify factors influencing massive blood transfusions in liver transplantation.
Main Methods:
- A retrospective analysis of 783 orthotopic liver transplants performed between January 2006 and December 2016.
- Comparison of liver grafts from DCD donors (n=69) versus DBD donors (n=265).
- Statistical analysis of patient demographics, perioperative variables, transfusion requirements, and survival rates.
Main Results:
- No significant differences in patient demographics or pre-transplant scores (MELD, Child-Pugh) between DCD and DBD groups.
- Grafts from DCD donors required significantly more red blood cell (9 vs 6 units) and fresh frozen plasma (10 vs 9.5 units) transfusions (P < .004).
- Uncontrolled DCD status and higher MELD scores were independently associated with massive blood transfusion (>6 RBC units).
Conclusions:
- Liver grafts from DCD donors are associated with a higher need for hemoderivative transfusions compared to grafts from DBD donors.
- The findings underscore the importance of managing transfusion needs in DCD liver transplant recipients.
- Further research may explore strategies to mitigate transfusion requirements with DCD grafts.
Introduction:
Intraoperative bleeding during liver transplantation has been correlated with a higher risk of morbidity and mortality and decrease in patient and graft survival.
Materials And Methods:
Between January 2006 and December 2016 we performed 783 orthotopic liver transplants. After applying exclusion criteria, we found liver grafts from donors after circulatory death (DCD, group A) were used in 69 patients and liver grafts from donors after brain death (group B) were used in 265 patients.
Results:
No difference was found in terms of sex, body mass index, Model for End-Stage Liver Disease score, indication for transplantation, intensive care unit stay, and Child-Pugh score. The mean transfusion of hemoderivates was as follows: red blood cell 9 (0-28) units in group A vs 6 (0-20) units in group B (P = .004) and fresh frozen plasma 10 (0-29) units in group A vs 9.5 (0-23) in group B (P = .000). The only 2 factors related to massive blood transfusion (>6 units of red blood cell) were uncontrolled DCD condition (odds ratio = 2.38; 95% confidence interval, 1.32-4.31; P = .004), and higher Model for End-Stage Liver Disease score (odds ratio = 2.63; 95% confidence interval, 1.53-4.55; P = .001). Survival at 1, 3, and 5 years was 81.3%, 70.2%, and 68.9% in group A vs 89%, 83.7%, and 78% in group B (P = .070).
Conclusion:
The use of liver grafts from DCDs is associated with increased necessity of transfusion of hemoderivates in comparison with the use of liver grafts from donors after brain death.
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