Intraoperative blood loss and transfusion during primary pediatric liver transplantation

A single-center experience

Joshua A. Villarreal, Dor Yoeli, Ruth L. Ackah, Rohini R. Sigireddi, Jordan K. Yoeli, Michael Kueht, N. Thao N. Galvan, Ronald T. Cotton, Abbas Rana, Christine A. O’Mahony, John A. Goss

Research output: Contribution to journalArticle

Abstract

Children undergoing liver transplantation are at a significant risk for intraoperative hemorrhage and thrombotic complications, we aim to identify novel risk factors for massive intraoperative blood loss and transfusion in PLT recipients and describe its impact on graft survival and hospital LOS. We reviewed all primary PLTs performed at our institution between September 2007 and September 2016. Data are presented as n (%) or median (interquartile range). EBL was standardized by weight. Massive EBL and MT were defined as greater than the 85th percentile of the cohort. 250 transplantations were performed during the study period. 38 (15%) recipients had massive EBL, and LOS was 31.5 (15-58) days compared to 11 (7-21) days among those without massive EBL (P < 0.001). MT median LOS was 34 (14-59) days compared to 11 (7-21) days among those without MT (P = 0.001). Upon backward stepwise regression, technical variant graft, operative time, and transfusion of FFP, platelet, and/or cryoprecipitate were significant independent risk factors for massive EBL and MT, while admission from home was a protective factor. Recipient weight was a significant independent risk factor for MT alone. Massive EBL and MT were not statistically significant for overall graft survival. MT was, however, a significant risk factor for 30-day graft loss. PLT recipients with massive EBL or MT had significantly longer LOS and increased 30-day graft loss in patients who required MT. We identified longer operative time and technical variant graft were significant independent risk factors for massive EBL and MT, while being admitted from home was a protective factor.

Original languageEnglish (US)
Article numbere13449
JournalPediatric Transplantation
Volume23
Issue number4
DOIs
StatePublished - Jun 1 2019
Externally publishedYes

Fingerprint

Blood Transfusion
Liver Transplantation
Pediatrics
Transplants
Graft Survival
Operative Time
Weights and Measures
Platelet Transfusion
Transplantation
Hemorrhage
Protective Factors

Keywords

  • estimated blood loss
  • graft survival
  • length of stay
  • pediatric liver transplantation

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Transplantation

Cite this

Intraoperative blood loss and transfusion during primary pediatric liver transplantation : A single-center experience. / Villarreal, Joshua A.; Yoeli, Dor; Ackah, Ruth L.; Sigireddi, Rohini R.; Yoeli, Jordan K.; Kueht, Michael; Galvan, N. Thao N.; Cotton, Ronald T.; Rana, Abbas; O’Mahony, Christine A.; Goss, John A.

In: Pediatric Transplantation, Vol. 23, No. 4, e13449, 01.06.2019.

Research output: Contribution to journalArticle

Villarreal, JA, Yoeli, D, Ackah, RL, Sigireddi, RR, Yoeli, JK, Kueht, M, Galvan, NTN, Cotton, RT, Rana, A, O’Mahony, CA & Goss, JA 2019, 'Intraoperative blood loss and transfusion during primary pediatric liver transplantation: A single-center experience', Pediatric Transplantation, vol. 23, no. 4, e13449. https://doi.org/10.1111/petr.13449
Villarreal, Joshua A. ; Yoeli, Dor ; Ackah, Ruth L. ; Sigireddi, Rohini R. ; Yoeli, Jordan K. ; Kueht, Michael ; Galvan, N. Thao N. ; Cotton, Ronald T. ; Rana, Abbas ; O’Mahony, Christine A. ; Goss, John A. / Intraoperative blood loss and transfusion during primary pediatric liver transplantation : A single-center experience. In: Pediatric Transplantation. 2019 ; Vol. 23, No. 4.
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AU - Villarreal, Joshua A.

AU - Yoeli, Dor

AU - Ackah, Ruth L.

AU - Sigireddi, Rohini R.

AU - Yoeli, Jordan K.

AU - Kueht, Michael

AU - Galvan, N. Thao N.

AU - Cotton, Ronald T.

AU - Rana, Abbas

AU - O’Mahony, Christine A.

AU - Goss, John A.

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AB - Children undergoing liver transplantation are at a significant risk for intraoperative hemorrhage and thrombotic complications, we aim to identify novel risk factors for massive intraoperative blood loss and transfusion in PLT recipients and describe its impact on graft survival and hospital LOS. We reviewed all primary PLTs performed at our institution between September 2007 and September 2016. Data are presented as n (%) or median (interquartile range). EBL was standardized by weight. Massive EBL and MT were defined as greater than the 85th percentile of the cohort. 250 transplantations were performed during the study period. 38 (15%) recipients had massive EBL, and LOS was 31.5 (15-58) days compared to 11 (7-21) days among those without massive EBL (P < 0.001). MT median LOS was 34 (14-59) days compared to 11 (7-21) days among those without MT (P = 0.001). Upon backward stepwise regression, technical variant graft, operative time, and transfusion of FFP, platelet, and/or cryoprecipitate were significant independent risk factors for massive EBL and MT, while admission from home was a protective factor. Recipient weight was a significant independent risk factor for MT alone. Massive EBL and MT were not statistically significant for overall graft survival. MT was, however, a significant risk factor for 30-day graft loss. PLT recipients with massive EBL or MT had significantly longer LOS and increased 30-day graft loss in patients who required MT. We identified longer operative time and technical variant graft were significant independent risk factors for massive EBL and MT, while being admitted from home was a protective factor.

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