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Pediatr Transplant. 2016 Dec;20(8):1065-1071. doi: 10.1111/petr.12794. Epub 2016 Sep 29.

Preoperative risk factors for intra-operative bleeding in pediatric liver transplantation.

Author information

1
Pediatric surgery unit, Hôpital Necker enfants malades, Paris, France.
2
Clinical research unit, Hôpital Necker enfants malades, Paris, France.
3
Anesthesiology unit, Hôpital Necker enfants malades, Paris, France.
4
Intensive care unit, Hôpital Necker enfants malades, Paris, France.
5
Hepatology unit, Hôpital Necker enfants malades, Paris, France.

Abstract

This study analyzes the preoperative risk factors for intra-operative bleeding in our recent series of pediatric LTs. Between November 2009 and November 2014, 84 consecutive isolated pediatric LTs were performed in 81 children. Potential preoperative predictive factors for bleeding, amount of intra-operative transfusions, postoperative course, and outcome were recorded. Cutoff point for intra-operative HBL was defined as intra-operative RBC transfusions ≥1 TBV. Twenty-six patients (31%) had intra-operative HBL. One-year patient survival after LT was 66.7% (CI 95%=[50.2-88.5]) in HBL patients and 83.8% (CI 95%=[74.6-94.1]) in the others (P=.054). Among 13 potential preoperative risk factors, three of them were identified as independent predictors of high intra-operative bleeding: abdominal surgical procedure(s) prior to LT, factor V level ≤30% before transplantation, and ex situ parenchymal transsection of the liver graft. Based on these findings, we propose a simple score to predict the individual hemorrhagic risk related to each patient and graft association. This score may help to better anticipate intra-operative bleeding and improve patient's management.

KEYWORDS:

hemorrhage; pediatric liver transplantation; predictive factors; surgery; transfusion

PMID:
27681842
DOI:
10.1111/petr.12794
[Indexed for MEDLINE]

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