PRIMARY LIVER-TRANSPLANTATION WITHOUT TRANSFUSION OF RED-BLOOD-CELLS

Background. This study examines factors associated with the performanc e of orthotopic liver transplantation (OLT) without red blood cell (RB C) transfusion. Methods. Between January 1992 and December 1994, 306 p rimary OLTs were performed with recipients divided into two groups: gr oup 1 patients (61 recipients, 20% of total) underwent transplantation without packed RBCs, and group 2 patients (245 recipients, 80% of cas es) received a transfusion of at least I unit of RBCs during operation . Results. Recipients in group I compared with group 2 had less advanc ed liver disease (20% hospitalized and 48% Child's class C versus 58% hospitalized and 73% Child's class C, p < 0.01) and lower frequency of right upper quadrant surgery (13% versus 25%, p < 0.05). Group I reci pients also had significantly higher preoperative hematocrits (38% ver sus 33%, p < 0.01), lower-prothrombin times (15.4 versus 16.7 seconds, p < 0.001) and partial thromboplastin times (36.9 versus 42.2 seconds , p < 0.01), a greater proportion of patients transplanted by piggybac k technique (87% versus 59%, p < 0.001), and shorter operative rimes ( 7.9 hours versus 9.2 hours, p < 0.001). Moreover, a greater percentage of patients underwent OLT without RBC transfusion in each successive year: 9% in 1992, 21% in 1993, and 31% in 1934 (p < 0.001). Logistic r egression analysis showed the following factors to be independent pred ictors of OLT without RBC transfusion: preoperative Hct, United Networ k of Organ Sharing status, piggyback technique, operative time, and ye ar of transplantation. Conclusions. OLT can be performed without trans fusion of RBCs in recipients with less advanced liver disease, and sur gical technique, along with increased experience by the transplant tea m are important factors.