Bloodless living donor liver transplantation: Risk factors, outcomes, and diagnostic predictors

Massive bleeding is often unavoidable during liver transplantation (LT). However, blood transfusions are associated with risks and should be avoided whenever possible. This study compares preoperative factors and outcomes between non-transfusion and transfusion groups to identify variables that could be used to predict bloodless surgery in living donor liver transplantation (LDLT) patients. We conducted a retrospective study of 87 LDLT patients. The group of patients who did not require packed red blood cell (PRBC) transfusion (non-PRBC group, n = 44) was compared with those who did (PRBC group, n = 43). We compared risk factors, fluid management, and outcomes between the groups and identified variables for prediction of transfusion during LDLT. Compared with the PRBC group, the non-PRBC group had a lower model for end-stage liver disease (MELD) score (8.1 ± 1.1 vs 18.2 ± 8.8), international normalized ratio (INR) (1.16 ± 0.1 vs 1.80 ± 0.94), and partial thromboplastin time (PTT) (37.1 ± 6.3 vs 54.1 ± 24.0), but higher hemoglobin (Hb) (13.6 ± 1.6 vs 11.5 ± 2.2) and hematocrit (HCT) (39.1 ± 4.4 vs 32.6 ± 6.0). The non-PRBC group were more likely to receive colloid and albumin but had shorter intensive care unit (ICU) and hospital length of stay. The area under the receiver operative characteristic (ROC) curve of the MELD score was the highest (91%) using a cutoff value of 10.5. Patients without PRBC transfusion during LDLT were in better condition preoperatively and had better outcomes. The MELD score is a significant predictor for PRBC transfusion.