NIV Congres
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Increase in RBC transfusion requirements during orthotopic liver transplantation after market withdrawal of aprotinin
Arshad, F., Westerkamp, A. C., Lisman, T., Porte, R.J., Boer, M. de
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Background Blood loss during orthotopic liver transplantation (OLT) remains a topic of concern. Blood loss is currently managed by transfusion of red blood cells (RBC), fresh frozen plasma (FFP), platelet concentrates, fibrinogen and/or antifibrinolytic drugs. Besides evolvement in surgical techniques, including the piggyback implantation, a restrictive transfusion policy and a better overall understanding of hemostasis mechanisms has led to a significant decrease in blood loss and transfusion requirements in the past decades. We, amongst others, previously reported transfusion free OLT in around 30% of primary liver transplantations. Unfortunately, in the past years we are observing an increase in RBC transfusion requirements in our center. We hypothesized that this increase is related to the withdrawal of the antifibrinolytic drug aprotinin from the market.
Objective Aim of this study was to analyze recipient, donor, and surgical factors that can explain the recent increase in transfusion requirements.
Methods: Blood transfusion records and clinical outcomes for 373 consecutive adult patients undergoing primary OLT ‘s in our center between 2000 and 2012 were analyzed. We considered a variety of potential causes that may, including the discontinuation of the antifibrinolytic drug aprotinin in 2007.
Results The proportion of patients without any RBC transfusion decreased from 39% to 19 % before and after 2007 (p<0,001). The median amount of RBC transfusion increased from 2,3 ( IQR 0- 5,7) to 4,6 units( IQR 1,8-10,0) before and after 2007 (p<0,001). In a uni- and multivariate analysis, using binary logistic regression models, aprotonin became highly significant in predicting RBC transfusion (OR 2,371, 95%CI: 1,350-4,166, p=0,003). Other significant factors in the multivariate model were age recipient, cold ischemia time (cit), female recipient gender and MELD score.
Conclusion RBC transfusion has significantly increased in the era after market withdrawal of aprotinin in 2007. These results plea for reconsideration of aprotinin in OLT.