Predictors of Intraoperative Frozen Plasma Transfusion in Liver Transplantation

Liver transplantation (LT) is often accompanied by large intraoperative transfusions of blood products and worsens the patient's prognosis. The aim of our study was to identify the predictors of intraoperative frozen plasma (FP) transfusion in LT. At the same time, the effect of intraoperative plasma transfusion on clinical outcomes was evaluated as well.

Our retrospective study included 114 adult patients undergoing LT between January 1, 2020 and November 30, 2021. Patient demographics, including age, gender, and weight, were acquired. Patients were classified into one of two cohorts, FP transfusion and no FP transfusion, according to intraoperative FP transfusion or not. We used non-parametric Mann-Whitney U test and chi-squared test to compare the differences between the two groups. Variables significantly associated with intraoperative FP transfusion were included in multivariate logistic analysis. The multivariate logistic analysis was used to analyze the independent risk factors of intraoperative FP transfusion.

Preoperative Fg (OR = 2.441, CI: 1.169 - 5.096, p = 0.017) and packed red blood cell transfusion (OR = 0.595, CI: 0.447 - 0.791, p < 0.001) were found to be predictive of FP transfusion. Intraoperative FP transfusions were significantly associated with worse clinical outcomes of postoperative PLT count, Fg, inpatient days, and length of ICU stay. There were statistically significant differences between the FP transfusion group and the non-FP transfusion group.

Preoperative Fg and intraoperative packed red blood cell transfusion were predictive of intraoperative FP transfusion. Intraoperative FP transfusion can reduce postoperative platelet and fibrinogen, prolong the hospital stay of patients, and increase the length of ICU stay.