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.
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Article info
Publication history
Published online: January 23, 2023
Accepted:
January 20,
2023
Received:
November 10,
2022
Publication stage
In Press Corrected ProofFootnotes
☆All the authors read and approved the final version of the paper.
Identification
Copyright
© 2023 International Hepato-Pancreato-Biliary Association Inc. Published by Elsevier Ltd. All rights reserved.
