Balanced Blood Product Transfusion during Liver Transplantation.

IntroductionThis study was conducted to determine whether an intra-operative ratio of at least 1:1:2 of fresh frozen plasma (FFP):platelets (PLTs):packed red blood cells (pRBCs) improves outcomes in orthotopic liver transplantation (OLT). MethodsA single-center, retrospective study of deceased donor OLT recipients (MELD 15) requiring intra-operative pRBC transfusion (years 2013-2016). Patients were grouped into those receiving an intra-operative ratio of 1:1:2 of FFP:PLTs:pRBCs vs ratios <1:1:2. ResultsPatients in 1:1:2 group (n=150) and patients in <1:1:2 group (n=80) were matched for baseline characteristics (P>.05). Patients in the 1:1:2 group had lower pRBC and intra-operative blood product requirements (110.5 vs 19 +/- 1.4 units, P<.001, and 33 +/- 1.3 vs 43 +/- 3.3 units, P=.006, respectively), improved 1-month mortality (0 vs 8%, P=.002), improved 1-year survival (P=.004), less intra-operative cardiac arrest (3% vs 10%, P=.03), and shorter operating room time (389 +/- 7.2 vs 431 +/- 17.2minutes, P=.03). After multivariate adjustment for baseline and intra-operative variables, balanced blood product transfusion (BBPT) was significantly associated with less intra-operative pRBC transfusion (95% confidence interval: 0.60-0.72). ConclusionBalanced blood product transfusion is associated with reduced transfusion requirements in OLT.