Balanced blood product transfusion during liver transplantation

This study was conducted to determine whether an intra‐operative ratio of at least 1:1:2 of fresh frozen plasma ( FFP ):platelets ( PLT s):packed red blood cells ( pRBC s) improves outcomes in orthotopic liver transplantation ( OLT ). Methods A single‐center, retrospective study of deceased donor OLT recipients ( MELD ≥15) requiring intra‐operative pRBC transfusion (years 2013‐2016). Patients were grouped into those receiving an intra‐operative ratio of ≥1:1:2 of FFP : PLT s: pRBC s vs ratios <1:1:2. Results Patients in ≥1:1:2 group (n = 150) and patients in <1:1:2 group (n = 80) were matched for baseline characteristics ( P  > .05). Patients in the ≥1:1:2 group had lower pRBC and intra‐operative blood product requirements (11 ± 0.5 vs 19 ± 1.4 units, P  < .001, and 33 ± 1.3 vs 43 ± 3.3 units, P  = .006, respectively), improved 1‐month mortality (0 vs 8%, P  = .002), improved 1‐year survival ( P  = .004), less intra‐operative cardiac arrest (3% vs 10%, P  = .03), and shorter operating room time (389 ± 7.2 vs 431 ± 17.2 minutes, P  = .03). After multivariate adjustment for baseline and intra‐operative variables, balanced blood product transfusion ( BBPT ) was significantly associated with less intra‐operative pRBC transfusion (95% confidence interval: 0.60‐0.72). Conclusion Balanced blood product transfusion is associated with reduced transfusion requirements in OLT .