Poor prediction of blood transfusion requirements in adult liver transplantations from preoperative variables

Study Objective: To assess the ability of preoperative information to predi ct intraoperative blood transfusion requirements in adult orthotopic liver transplantation Design: Retrospective review. Setting: Liver transplantation program in a referral center Patients: 583 sequential adult patients undergoing orthotopic liver transpl antation Measurements: Preoperative variables with a previously demonstrated relatio nship to intraoperative transfusion were identified from the literature. Th ese variables were then collected retrospectively from 583 consecutive live r transplantations. Relationships between these and intraoperative blood tr ansfusion requirements were examined by both univariate analyses and multip le linear regression analysis. Results: Univariate analysis revealed significant associations between bloo d transfused and the following preoperative variables: age, gender, diagnos is, presence of grade 3 or 4 encephalopathy, pseudocholinesterase, creatini ne, bilirubin, mean pulmonary artery pressure, activated partial thrombopla stin time, and platelet count. Multiple linear regression analysis with cor rection for diagnosis identified age, creatinine, bilirubin, and pseudochol inesterase as independent predictors; for the final model r(2) = 0.22. Conclusion: Preoperative variables are poor predictors of intraoperative tr ansfusion requirements even when significant associations exist, identifyin g a small proportion of the variability observed. A predictive approach bas ed on this method would be too inaccurate to be of clinical use. The majori ty of the variability in transfusion requirements during liver transplantat ion most likely results from intraoperative and donor organ factors. (C) 20 00 by Elsevier Science Inc.