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CARDIOVASCULAR ANESTHESIA

Institutional Variability in Transfusion Practice for Liver Transplantation

Yves Ozier, MD^*, Fabienne Pessione, MD, Emmanuel Samain, MD, and Françoise Courtois, MD for the French Study Group on Blood Transfusion in Liver Transplantation

*Department of Anesthesiology, Hôpital Cochin (AP-HP), Université René Descartes, Paris, France; Etablissement Français des Greffes, Paris, France; Department of Anesthesiology, Hôpital Beaujon (AP-HP), Clichy, France; Etablissement Français du Sang, Paris, France

Address correspondence and reprint requests to Yves Ozier, MD, Département d’Anesthésie-Réanimation Chirurgicale, Hôpital Cochin, 123 Boulevard de Port Royal, F-75679 Paris Cedex 14. Address e-mail to yves.ozier{at}cch.ap-hop-paris.fr

We prospectively evaluated the institutional variability in perioperative transfusion therapy in orthotopic liver transplantation (OLT). Adult OLTs completed during a 12-mo period were studied until the 48th postoperative hour at 8 centers. A multivariate analysis using mixed-effects logistic regression included variables predisposing to blood loss and a center random effect. In addition, the influence of the calculated perioperative hemoglobin (Hb) loss on the individual probability of receiving red blood cells (RBCs), fresh frozen plasma (FFP), and platelets in excess of the overall median were explored. The analysis was performed on 301 cases. The overall median numbers transfused were 5 RBC units, 6 FFP units, and the median platelet dose was 5.10¹¹, with significant intercentric differences in the proportions of cases given more than the overall median. Intercentric differences remained significant after adjustment for factors independently associated with a large blood component use. Intercentric differences in RBCs, FFP, and platelet use decreased but persisted after adjustment for the perioperative Hb loss. Intercentric differences in RBC use disappeared after adjustment for the postoperative Hb concentration. The significant heterogeneity in transfusion therapy mandates reassessment of the rational use of blood products in OLT.

IMPLICATIONS: We evaluated transfusion practices in liver transplantation at eight centers. There is a marked heterogeneity in blood component use which is unrelated to differences in the preoperative recipient status and, partly, to differences in blood loss.

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