Early results of intraoperative blood transfusion in adult liver transplantation cases

In end-stage liver failure, the therapeutic method other than palliative treatment is liver transplantation. Since liver failure brings with it the deterioration of other organ systems, transplantation anesthesia and surgery require more attention and care. In our study, the early postoperative effects of blood transfusion applied in the intraoperative period in liver transplants with living donors over the age of 18 performed at Akdeniz University Medical Faculty Hospital between January 2015 and December 2020 were retrospectively investigated. 114 patients were included in the study, and patient data were recorded using patient files, anesthesia slips and hospital database. The data includes patients' demographic characteristics, comorbidities, MELD and CHILD scores, preoperative and postoperative laboratory values, the amount of blood and blood products transfused during the intraoperative period, arterial blood gas values, postoperative complications and length of hospital-intensive care stay. Mann Whitney U test and Wilcoxon Signed ranks test were used for statistical evaluation. In the analysis of more than two measurements, variance analysis and then Bonferroni correction were performed in repeated measurements in cases where parametric test assumptions were met, and if not, Freidman test and post hoc pairwise comparisons tests were performed. The statistical significance level was accepted as 0.05 in the study. Of the 114 patients included in the study, 30 (26.3%) were female and 84 (73.7%) were male. The most common cause of liver failure etiology was HBV (30.7%), and the least was Wilson's disease (1.8%). When the comorbid diseases of the patients were evaluated, it was observed that liver failure was most frequently accompanied by DM. Considering that there is a link between the impairments in carbohydrate metabolism and chronic liver disease, it is inevitable that existing liver failure will lead to impaired blood sugar regulation, increased insulin resistance and DM. The main purpose of our study was to evaluate the postoperative results of intraoperative period blood transfusions. It was observed in our study that the preoperative patient clinic also affected the rate of blood transfusion in the intraoperative period. In the patient group with a high preoperative MELD score, it was observed that blood and blood product transfusion was applied more in the intraoperative period. This result is thought to be related to the coagulation parameters of the patient group with high MELD score being impaired and portal hypertension being more frequent in the group with high MELD score. The rate of blood transfusion applied in the intraoperative period also affected the postoperative morbidity of the patients. With the increase in blood transfusion rate, the incidence of AKI in the postoperative period has also increased. After blood transfusion, the inflammatory state may change and tissue oxygenation may be impaired, and we may encounter with deterioration in organ systems after transfusion. Similar to our study, many studies have shown that increased rates of blood transfusion resulted in post-transfusion renal damage. If we evaluate the postoperative mortality according to blood transfusion, in our study, 1-year mortality was found at the rate of 11.5% in the group that received blood transfusion and 10.0% in the group that did not receive blood transfusion. Although the result of our study is not statistically significant, many studies advocating the negative effects of blood and blood product transfusion on 1-year mortality appear in the literature. In conclusion, the management of intraoperative blood transfusion in liver transplantation starts from the preoperative period. Good patient clinic in the preoperative period, especially lower MELD and CHILD scores, creates less intraoperative coagulopathy and lower bleeding risk. Determining the coagulation profile in the intraoperative period using various viscoelastic tests is also important in order to prevent unnecessary transfusions. In the light of this information, there is a need for more studies and studies involving more patient groups in transplantation surgery and anesthesia management.