Impact of massive hemorrhage on outcome in patients with orthotopic liver transplant: A retrospective unicenter study

Abstract

Despite advancements in surgical and anesthetic techniques, significant bleeding remains a common challenge during orthotopic liver transplantation (OLT). The extensive nature of the surgical procedure, combined with the patient's fragile coagulation profile, places individuals undergoing OLT at a high risk for massive hemorrhage (MH). Blood transfusions and hemostatic products are frequently required and can be life-saving. However, these resources are often limited, and their use may be associated with numerous complications. This study aimed to evaluate the impact of MH on the day of surgery on the outcomes of patients undergoing OLT from brain-dead donors at our institution. We conducted a retrospective single-center study including all adult patients who underwent OLT from brain-dead donors at the Emergency County Clinical Hospital "Saint Spiridon" in Iași. Preoperative circulating blood volume was calculated for each patient and compared with the estimated blood loss on the day of surgery. Patients who lost >1 circulating blood volume were classified as having experienced MH. The study population was divided into 2 groups: those with MH and those without. Outcomes were assessed based on 30-day and 1-year mortality, as well as medical and surgical complications. The study included 53 patients, with a median blood loss of 5500 mL (4650 mL). MH occurred in 26 patients (49.1%). Patients with a lower body mass index (24.3 vs 26.6, P = .028) and thrombocytopenia (55.5 vs 75 × 10³/µL, P = .04) were more likely to experience MH. Those with MH had higher rates of cardiovascular complications (38.5% vs 7.4%, P = .007), infectious complications (69.2% vs 37%, P = .009), and surgical reintervention (34.6% vs 11.1%, P = .04). Mortality rates at 30 days and 1 year did not significantly differ between patients with and without MH. MH adversely affects the outcomes of OLT patients, as evidenced by increased rates of cardiovascular and infectious complications and a higher likelihood of requiring surgical reintervention.

Keywords: liver transplant; massive hemorrhage; medical complications; mortality; surgical complications.