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Portal hypertension has NO role in perioperative bleeding during liver transplantation with systematic porto-caval shunt

Published:January 23, 2023DOI:https://doi.org/10.1016/j.hpb.2023.01.009

      Abstract

      Background

      More than a half of patients undergoing liver transplantation (LT) receive intraoperative transfusion. Portal hypertension (PHT) may contribute to perioperative blood loss. We study the relationship between preoperative hepatic venous pressure gradient (HVPG) values and intraoperative transfusion requirements in adult patients undergoing LT.

      Methods

      160 cirrhotic patients undergoing first elective LT (2009-2019) with an HVPG measurement within the previous 6 months were included. Surgical technique was piggyback with portocaval shunt (PCS). The association of HVPG and other variables with transfusion requirements and blood loss were studied.

      Results

      Blood loss (ml/kg) was positively correlated with HVPG, among other variables, but at multivariable analysis it only remained associated with MELD-Na and HCC indication. Regarding RBC transfusion, MELD-Na and hemoglobin were independently associated with the need and magnitude of RBC transfusion. Subanalysis by surgical stage (hepatectomy, anhepatic, neohepatic) and by serial HVPG cut-offs found no clear associations with either bleeding or transfusion.

      Discussion

      The severity of PHT plays a minor role on bleeding and transfusion during LT in a contemporary cohort with systematic PCS. Main determinants of transfusion are liver function and baseline hemoglobin, which would seem the suitable goal to optimize transfusion in LT.

      Keywords

      abbreviations:

      ASA (American Society of Anaesthesiologists), BMI (Body mass index), CSPH (clinically significant portal hypertension), HCC (Hepatocellular carcinoma), HVPG (Hepatic venous pressure gradient), MELD (Model for end-stage liver disease), LT (Liver transplantation), LDLT (living donor liver transplantation), PCS (Porto-caval shunt), PHT (Portal hypertension), TIPS (Trans-jugular intrahepatic portal-systemic shunt), RBC (Red blood cells)
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