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Korean J Anesthesiol. 2019 Aug 3. doi: 10.4097/kja.19108. [Epub ahead of print]

Preoperative risk factors for massive transfusion, prolonged ventilation requirements and mortality in patients undergoing liver transplantation.

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Department of Anesthesiology, University of California, San Diego, La Jolla, CA.
Department of Biomedical Informatics, University of California, San Diego, La Jolla, CA.



Despite improvements in techniques and management of liver transplant patients, numerous perioperative complications remain which contribute to perioperative mortality. Models to predict intraoperative massive blood transfusion, prolonged mechanical ventilation, or in-hospital mortality in liver transplant recipients have not been identified.


A retrospective observational analysis was conducted on data collected from 124 orthotopic liver transplants performed at a single institution between 2014 and 2017. A multivariable logistic regression using backwards elimination was performed for three defined outcomes (massive transfusion ≥ 10 units PRBC, prolonged mechanical ventilation >24 hours, and in-hospital mortality) to identify associations with preoperative characteristics.


Statistically significant (P < 0.05) associations with massive transfusion ≥ 10 units PRBC were hepatocellular carcinoma and preoperative transfusion of packed red blood cells. Significant associations with prolonged mechanical ventilation >24 hours were hepatitis C, alcoholic hepatis, elevated preoperative ALT, and hepatorenal syndrome. Male gender was protective for requiring prolonged mechanical ventilation. End-stage renal disease and hepatitis B were significantly associated with increased in-hospital mortality.


This study identified risk factors associated with common perioperative complications of liver transplantation. These factors may assist practitioners in risk stratification and may form the basis for further investigations of potential interventions to mitigate these risks.


blood transfusion; liver cirrhosis; liver transplantation; mechanical ventilation

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