Abstract

NM-246

Red Blood Cell Transfusion in Pediatric Orthotopic Liver Transplantation: An evaluation of 278 liver transplantations

¹Tran L, ²Mazariegos G, ²Davis P
¹University of Pittsburgh Medical Center, Pittsburgh, PA, USA; ²Children's Hospital of Pittsburgh of UPMC, Pittsburgh, PA, USA

Introduction:
Liver transplantation in children is often associated with coagulopathy and significant blood loss. Available data is limited. In this retrospective study, we assessed transfusion practices in pediatric patients undergoing liver transplantation at a single institution over the course of nine years.

Methods:
Data was retrospectively collected from electronic medical records at the Children’s Hospital of Pittsburgh of University of Pittsburgh Medical Center. All patients who underwent liver transplantation from January 2008 to June 2017 were included.

Results:
From January 2008 to June 2017, there were 278 liver transplants. The number of primary transplants were 259, second re-transplants 15, and third re-transplants 4. The average age was 6.9 years. 144 of 278 patients (51.8%) were female (Table 1). Biliary atresia, maple syrup urine disease, urea cycle defect, and liver tumor were the leading indications accounting for 66 (23.7%), 45 (16.2%), 24 (8.6%), and 23 (8.3%) of transplants respectively.

76 (27.3%) cases did not require red blood cell transfusions (Figure 1). Among those transfused, 181 (89.6%) of the cases required less than 1 blood volume (BV). The median BV transfused among all cases was 0.21 (Q1 = 0, Q3 = 0.45).

There is a trend toward higher volume transfusions among infants (median 0.46 BV) compared to children greater than 12 months of age (0.12 BV).

By diagnosis, the group requiring the highest median volume transfusion were patients with TPN-related liver failure (3.41 BV) followed by patients undergoing repeat transplants (0.6 BV).

Comparison of primary versus repeat transplants show a trend towards higher volume transfusions in third transplants (median 2.71 BV), compared to second transplants (0.43 BV) and primary transplants (0.18 BV).

Discussion:
In contrast to historically reported trends, evaluation of current transfusion practices reveal that most patients undergoing liver transplantation receive less than one blood volume of packed red blood cells. The transfusion requirements in this cohort of patients is markedly different from the average and range of blood volume transfusion requirements of 3.95 and 0.5-25 respectively, previously reported by Borland et al. in the first 50 patients reported from this institution (1). Our current study shows that more than one in four transplantations require no transfusion at all. Risk factors for greater transfusion need include younger age, TPN related liver failure, and repeat transplantation.

Reference:
(1) Borland LM, Roule M, Cook DR. Anesthesia for pediatric orthotopic liver transplantation. Anesth Analg. 1985; 64: 117-24.