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CARDIOVASCULAR ANESTHESIOLOGY

The Impact of Intraoperative Transfusion of Platelets and Red Blood Cells on Survival After Liver Transplantation

Marieke T. de Boer, MD^*, Michael C. Christensen, Dr PH, Mikael Asmussen, MSc, Christian S. van der Hilst, MSc, Herman G. D. Hendriks, MD, PhD, Maarten J. H. Slooff, MD, PhD^*, and Robert J. Porte, MD, PhD^*

From the *Department of Surgery, Section of Hepatobiliary Surgery and Liver Transplantation, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands; Global Development, Novo Nordisk A/S, Bagsvaerd, Denmark; and Office for Medical Technology Assessment, Department of Anesthesiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.

Address correspondence and reprint requests to Robert J. Porte, MD, PhD, Department of Surgery, Section Hepatobiliary Surgery and Liver Transplantation, University Medical Center Groningen, P.O. Box 30.001, 9700 RB Groningen, The Netherlands. Address e-mail to r.j.porte{at}chir.umcg.nl.

Abstract

BACKGROUND: Intraoperative transfusion of red blood cells (RBC) is associated with adverse outcome after orthotopic liver transplantation (OLT). Although experimental studies have shown that platelets contribute to reperfusion injury of the liver, the influence of allogeneic platelet transfusion on outcome has not been studied in detail. In this study, we evaluate the impact of various blood products on outcome after OLT.

METHODS: Twenty-nine variables, including blood product transfusions, were studied in relation to outcome in 433 adult patients undergoing a first OLT between 1989 and 2004. Data were analyzed using uni- and multivariate stepwise Cox’s proportional hazards analyses, as well as propensity score-adjusted analyses for platelet transfusion to control for selection bias in the use of blood products.

RESULTS: The proportion of patients receiving transfusion of any blood component decreased from 100% in the period 1989–1996 to 74% in the period 1997–2004. In uni- and multivariate analyses, the indication for transplantation, transfusion of platelets and RBC were highly dominant in predicting 1-yr patient survival. These risk factors were independent from well-accepted indices of disease, such as the Model for End-Stage Liver Disease score and Karnofsky score. The effect on 1-yr survival was dose-related with a hazard ratio of 1.377 per unit of platelets (P = 0.01) and 1.057 per unit of RBC (P = 0.001). The negative impact of platelet transfusion on survival was confirmed by propensity-adjusted analysis.

CONCLUSION: This retrospective study indicates that, in addition to RBC, platelet transfusions are an independent risk factor for survival after OLT. These findings have important implications for transfusion practice in liver transplant recipients.

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