Hemoderivative Transfusion in Liver Transplantation: Comparison Between Recipients of Grafts From Brain Death Donors and Recipients of Uncontrolled Donors After Circulatory Death |
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| Affiliation: | 1. Unit 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;2. Department of Anesthesiology, Perioperative and Pain Medicine, “Doce de Octubre” University Hospital, Madrid, Spain;1. Departments of Internal Medicine H;2. Dermatology;3. Organ Transplantation Unit, Surgical Division;4. Nephrology, Tel Aviv Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel;1. Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan;2. School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan;3. Division of Transplantation Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan;4. Division of Pediatric Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan;5. Department of Medical Imaging and Radiological Technology, Yuanpei University of Medical Technology, Hsinchu, Taiwan;6. Department of Radiology, Yee Zen General Hospital, Taoyuan, Taiwan;1. Division of Nephrology, University of Arizona College of Medicine, Tucson, Arizona;2. Division of Endocrinology, The University of Texas Southwestern Medical Center, Dallas, Texas;3. Department of Radiology, Columbia University Medical Center, New York, New York;4. Booth School of Business, University of Chicago, Chicago, Illinois;5. Division of Nephrology, Columbia University Medical Center, New York, New York;6. Biomarkers Core Laboratory, Columbia University Medical Center, New York, New York;7. Division of Nephrology, Geisinger Medical Center, Danville, Pennsylvania;8. Department of Pediatrics, University of California San Francisco, San Francisco, California;9. Division of Nephrology, The University of Texas Southwestern Medical Center, Dallas, Texas;1. Division of Surgery, Department of Transplantation Surgery, St James''s University Hospital, Leeds, United Kingdom;2. Department of Renal Medicine, St James''s University Hospital, Leeds, United Kingdom;3. Department of Transplantation Surgery, King Faisal Specialist Hospital and Research Centre, Jeddah, Kingdom of Saudi Arabia;4. Cleveland Clinic Lerner College of Medicine, Cleveland Clinic Foundation, Cleveland, Ohio;1. Division of Transplant, Department of Surgery, University of Nebraska Medical Center, Omaha, Nebraska;2. Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin;1. Department of Plastic and Reconstructive Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea;2. Biomedical Research Institute, Department of Plastic and Reconstructive Surgery, Seoul National University College of Medicine, Seoul, Republic of Korea |
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| Abstract: | ![]()
IntroductionIntraoperative bleeding during liver transplantation has been correlated with a higher risk of morbidity and mortality and decrease in patient and graft survival.Materials and MethodsBetween 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.ResultsNo 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).ConclusionThe 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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