INTRAOPERATIVE BLOOD-LOSS IN PEDIATRIC LIVER-TRANSPLANTATION - ANALYSIS OF PREOPERATIVE RISK-FACTORS

The relative contribution of 14 preoperative risk factors to a high in traoperative blood loss was studied in 95 consecutive first pediatric orthotopic liver transplantations (OLT). Patients were distributed in two groups according to red blood cell (RBC) requirements. Wide interi ndividual RBC requirements were observed (median, 79 mL/kg; range, 4-5 86). The upper quartile of the population was defined as the high bloo d loss group and required 123 mL/kg or more (median, 161). On univaria te analysis, the high blood loss group had a significantly higher prop ortion of patients with portal vein hypoplasia, intraabdominal malform ations, signs of severe liver failure (encephalopathy, ascites, prolon ged prothrombin time), and requiring inpatient support. Age, previous abdominal surgery, and platelet count had no prognostic value. All var iables used in the univariate analysis were included in a stepwise log istic regression analysis. Only presence of portal vein hypoplasia, in patient support, and use of a reduced-size liver graft were independen tly associated with a high blood loss. Adjusted odds ratios were 40.4 (95% confidence interval; 5.9-278), 5.4 (1.6-17.9), and 3.8 (0.9-15.2) , respectively, highlighting the importance of portal vein hypoplasia as a risk factor for high blood loss.