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Published on: May 7, 2015
Validation of McCluskey Index for Massive Blood Transfusion Prediction in Liver Transplantation
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
The McCluskey index effectively predicts massive bleeding risk during liver transplants. This study validates its use, confirming its role in assessing transfusion needs for orthotropic liver transplantation (OLT) patients.
Area of Science:
- Hepatology
- Transplantation Surgery
- Anesthesiology
Background:
- The McCluskey index is a validated tool for predicting massive bleeding (>6 red blood cell units) in orthotropic liver transplantation (OLT).
- Assessing the efficacy of the McCluskey index at a specific institution is crucial for refining perioperative management protocols.
Purpose of the Study:
- To evaluate the predictive accuracy of the McCluskey index for massive bleeding during OLT at our institution.
- To determine if the index correlates with the need for hemoderivative transfusions in OLT recipients.
Main Methods:
- A retrospective analysis of 1016 OLT cases with sufficient transfusion data between May 1998 and December 2017.
- Patients were stratified into risk groups (low, medium, high, very high) based on the original McCluskey index criteria.
- Data on Model for End-Stage Liver Disease (MELD) score, body mass index, hospital stay, donor quality, and hemoderivative (red blood cells, plasma) transfusions were collected and analyzed.
Main Results:
- Significant differences in MELD scores were observed across the four risk groups (P < .001).
- While no significant differences were found in BMI or hospital stay, hemoderivative transfusions varied significantly.
- Red blood cell transfusion requirements were 7 units (low risk) to 12 units (very high risk), and plasma transfusions ranged from 12 units (low risk) to 13 units (very high risk), with statistically significant differences between groups (P < .001 for RBCs, P = .001 for plasma).
Conclusions:
- The McCluskey index serves as a reliable indicator for predicting hemorrhage risk in OLT patients.
- The index's predictive capability supports its utility in anticipating the necessity for blood product transfusions during OLT.
Background:
The McCluskey index has been used as a tool to predict massive bleeding (>6 red blood cells units) during orthotropic liver transplantation. The objective of this study is to verify its efficacy at our institution.
Materials And Methods:
Between May 1998 and December 2017, we performed 1216 orthotropic liver transplantations, of which 1016 had sufficient data registered with respect to hemoderivative transfusion. We divided these patients into groups based on the original study of McCluskey. This study was approved by the ethical committee of our Institution and was performed in accordance with the Declaration of Helsinki.
Results:
The mean Model for End-Stage Liver Disease score in the 4 groups was 7.5 (range, 7-8) for low risk; 13 (range, 3-32) for medium risk, 17 (range, 8-41) for high risk, and 25 (range, 11-36) for very high risk (P < .001). No significant differences were observed regarding body mass index or hospital stay. No differences have been found in the number of suboptimal donors among the groups. With respect to hemoderivative transfusions, we observed the following for red blood cells: 7 (range, 6-8) units for low risk; 5.5 (range, 0-74) for medium risk; 7 (range, 0-73) for high risk, and 12 (range, 5-30) for very high risk (P < .001) and transfusion of plasma: 12 (range, 10-15) units for low risk; 11 (range, 0-89) for medium risk; 14 (range, 0-76) for high risk, and 13 (range, 3-30) for very high risk (P = .001).
Conclusions:
The McCluskey index is a good indicator of the risk of hemorrhage and hence the necessity of transfusion.
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