Effect of intraoperative blood transfusion on patient outcome in hepatic transplantation

Objective: To evaluate the effect of intraoperative transfusion of red bloo d cells (RBCs) on patient and graft survival. Design: A retrospective study. Setting: A tertiary care referral center. Patients: Between January 1, 1992, and December 31, 1994, medical records f rom 225 adult patients who underwent primary liver transplantations were an alyzed. Results: Overall patient survival was 90% at 1 year and 86% at 3 years, whi le graft survival was 89% at 1 year and 85% at 3 years. The following facto rs were associated with patient and graft survival: age, sex, medical condi tion at the time of transplantation, and intraoperative transfusion of RBCs . When these factors were subjected to a multivariate analysis, all were in dependently associated with survival. Fifty-four recipients (24%) underwent transplantation without intraoperative transfusion of RBCs, while 171 reci pients (76%) received at least 1 U of RBCs intraoperatively. Recipients who did not receive transfusion of RBCs had higher patient and graft survival rates than patients who did receive RBCs. By multivariate analysis, transpl antation without intraoperative transfusion of RBCs no longer remained stat istically significant, and only sex and the patient's medical condition wer e independently associated with patient and graft survival. Patient and gra ft survival decreased if 5 or more U were transfused, but transfusion of 5 or more U was not independently associated with survival by multivariate an alysis. Conclusions: Increased transfusion requirement for RBCs was independently a ssociated with patient and graft survival. While transplantation without tr ansfusion of intraoperative RBCs was associated with superior patient and g raft survival, these effects were overridden by patient sex and medical con dition at the time of transplantation.