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Transfusion requirements during cadaveric and living donor pediatric liver transplantation

Abstract:  Surgical techniques that have been used during liver transplantation (LT) together with patient's coagulation profile and institutional practices are reported to have an effect on transfusion requirements. The aim of this study is to evaluate the transfusion requirement in both cadaveric (CDLT, n = 22) and living donor (LDLT, n = 24) pediatric LT performed in our institution. Balanced general anesthesia was used for all patients. Transfusion requirements were met to maintain a hemoglobin concentration of 8–10 g/dL, platelet level >50 × 103/mL, prothrombin time <20 s and hemodynamic course with observing heart rate, arterial and central venous blood pressures and hourly urine output. Blood loss was replaced by using whole blood. Both groups’ perioperative total blood and fresh‐frozen plasma (FFP) volumes transfused, fluid requirements and hemodynamic courses, standard coagulation profile and metabolic variables determined in time periods of operations, patients’ preoperative characteristics, operative features and postoperative events were compared. The mean transfusion requirements were 37.1 ± 33.4 and 74.8 ± 90.8 mL/kg of whole blood (p = 0.059) and 34.5 ± 24.9 and 51.5 ± 59.7 mL/kg of FFP for CDLT and LDLT, respectively (p = 0.519). The mean ages and mean body weights of the CDLT patients were higher than LDLT patients (9.7 ± 5.3 vs. 6.6 ± 4.4 yr, p = 0.015 and 32.4 ± 17.7 vs. 21.0 ± 14.8 kg, p = 0.032, respectively) while the mean operation time (493 ± 135 vs. 323  ± 93 min, p = 0.0001) and PELD score (13.1 ± 11.2 vs. 20.1 ± 11.8, p = 0.036) were higher for LDLT. In the entire population, multiple regression analysis showed that age, body weight and operation time have a significant combined effect on blood consumption (r2 = 0.29, p = 0.003) meanwhile operation time was found to be an effective single variable (p = 0.002). None of the single or combined variables was found to have a significant effect on FFP consumption (r2 = 0.17, p = 0.63) and crystalloid use (r2 = 0.19, p = 0.11). Hemodynamic courses of both groups were similar. The incidences of metabolic acidosis and hypothermia during the anhepatic periods were higher in the CDLT group (p < 0.05). However, transfusion requirement in the ICU were higher in LDLT group [6.9 ± 2.2 (n = 6) vs. 18.6 ± 19 (n = 11) mL/kg, p < 0.05] after LT. As a result of this study in a pediatric patient population, no statistical significance was found in whole blood transfusion and FFP requirements between CDLT and LDLT. Duration of the operation was the primary factor effecting transfusion volume showing the importance of continued small volume losses during uncomplicated LT in this small sized patient population. Transfusion need for pediatric LT should be individualized for each patient based on the intraoperative conditions including surgical and patient features.