• Blood transfusion
• platelet count
• thrombocytopenia
• transplants

• intraoperative
• liver transplant
• massive transfusion
• predictors

• Humans
• Male
• Adolescent
• Young Adult
• Adult
• Middle Aged
• Aged
• Female
• Liver Transplantation
• End Stage Liver Disease/surgery
• Blood Loss, Surgical
• Retrospective Studies
• Severity of Illness Index
• Blood Transfusion
• Hemoglobins/analysis

• Acid-base equilibrium
• Bicarbonate Ringer’s solution
• Crystalloid
• Liver function
• Liver transplantation

• Adult
• Humans
• Liver Transplantation
• Acid-Base Equilibrium
• Ringer's Solution
• Bicarbonates
• Sodium Bicarbonate
• Carcinoma, Hepatocellular
• Liver Neoplasms
• Living Donors
• Isotonic Solutions
• Acetates

• YLGX-WS-2020014 China Primary Health Care Foundation

• blood bank
• blood product
• liver transplant
• plasma
• platelet
• preparation protocols
• red blood cell
• transfusion requirements

The impact of perioperative blood transfusion on short- and long-term outcomes in pediatric living donor liver transplantation (PLDLT) must still be ascertained, mainly among young children. Clinical and surgical postoperative complications related to perioperative blood transfusion are well described up to three months after adult liver transplantation.

To determine whether transfusion is associated with early and late postoperative complications and mortality in small patients undergoing PLDLT.

We evaluated the effects of perioperative transfusion on postoperative complications in recipients up to 20 kg of body weight, submitted to PLDLT. A total of 240 patients were retrospectively allocated into two groups according to postoperative complications: Minor complications (n = 109) and major complications (n = 131). Multiple logistic regression analysis identified the volume of perioperative packed red blood cells (RBC) transfusion as the only independent risk factor for major postoperative complications. The receiver operating characteristic curve was drawn to identify the optimal volume of the perioperative RBC transfusion related to the presence of major postoperative complications, defining a cutoff point of 27.5 mL/kg. Subsequently, patients were reallocated to a low-volume transfusion group (LTr; n = 103, RBC ≤ 27.5 mL/kg) and a high-volume transfusion group (HTr; n = 137, RBC > 27.5 mL/kg) so that the outcome could be analyzed.

High-volume transfusion was associated with an increased number of major complications and mortality during hospitalization up to a 10-year follow-up period. During a short-term period, the HTr showed an increase in major infectious, cardiovascular, respiratory, and bleeding complications, with a decrease in rejection complications compared to the LTr. Over a long-term period, the HTr showed an increase in major infectious, cardiovascular, respiratory, and minor neoplastic complications, with a decrease in rejection complications. Additionally, Cox hazard regression found that high-volume RBC transfusion increased the mortality risk by 3.031-fold compared to low-volume transfusion. The Kaplan-Meier survival curves of the studied groups were compared using log-rank tests and the analysis showed significantly decreased graft survival, but with no impact in patient survival related to major complications. On the other hand, there was a significant decrease in both graft and patient survival, with high-volume RBC transfusion.

Transfusion of RBC volume higher than 27.5 mL/kg during the perioperative period is associated with a significant increase in short- and long-term postoperative morbidity and mortality after PLDLT.

• Liver transplantation
• Child
• Blood transfusion
• Outcome
• Liver cirrhosis
• Mortality

• Adult
• Blood Transfusion
• Child
• Child, Preschool
• Erythrocyte Transfusion/adverse effects
• Humans
• Liver Transplantation/adverse effects
• Living Donors
• Retrospective Studies

• Bleeding
• Coagulation
• Liver transplantation
• Thromboelastometry
• Transfusions

• Blood coagulation disorder
• Blood coagulation test
• End stage liver disease
• Liver transplantation
• Magnesium sulfate

• liver transplantation
• massive transfusion
• pRBC utilization
• patient blood management
• predictive model

From its inception the success of liver transplantation has been associated with massive blood loss. Massive transfusion is classically defined as > 10 units of red blood cells within 24 h, but describing transfusion rates over a shorter period of time may reduce the potential for survival bias. Both massive haemorrhage and transfusion are associated with increased risk of mortality and morbidity (need for dialysis/surgical site infection) following liver transplantation although causality is difficult to prove due to the observational design of most trials. The blood loss associated with liver transplantation is multifactorial. Portal hypertension secondary to cirrhosis results in extensive collateral circulation, which can bleed during hepatectomy particular if portal pressures are increased. Avoiding volume loading and maintenance of a low central venous pressure together with the use of vasopressors have been shown to reduce blood loss and transfusion during liver transplantation, but may increase the risk of renal impairment post-operatively. Coagulation defects may be present pre-transplant, but haemostasis is often re-balanced due to a deficit in both pro- and anti-coagulation factors. Further derangement of haemostasis may develop in the anhepatic and neohepatic phases due to absent hepatic metabolic function, hyperfibrinolysis and platelet sequestration in the donor liver. Point-of-care tests of coagulation such as the viscoelastic tests rotation thromboelastometry/thromboelastometry allow and more accurate and rapid assessment of these derangements in coagulation and guide the use of factor replacement and antifibrinolytics. Transfusion protocols guided by these tests have been shown to reduce transfusion rates compared with conventional coagulation tests, but have not shown improvements in mortality or morbidity. Pre-operative factors associated with massive transfusion include previous surgery, re-do transplantation, the aetiology and severity of liver disease. Intra-operatively the use of piggy-back technique and avoiding veno-veno bypass has been shown to reduced blood loss.

• Liver transplantation
• Massive transfusion
• Coagulopathy