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Incidence and predictors of massive bleeding in children undergoing liver transplantation: A single‐center retrospective analysis
Author(s) -
Kloesel Benjamin,
Kovatsis Pete G.,
Faraoni David,
Young Vanessa,
Kim Heung Bae,
Vakili Khashayar,
Goobie Susan M.
Publication year - 2017
Publication title -
pediatric anesthesia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.704
H-Index - 82
eISSN - 1460-9592
pISSN - 1155-5645
DOI - 10.1111/pan.13162
Subject(s) - medicine , liver transplantation , blood product , perioperative , incidence (geometry) , surgery , retrospective cohort study , single center , transplantation , population , blood transfusion , model for end stage liver disease , logistic regression , physics , environmental health , optics
Summary Background Liver transplantation represents a major surgery involving a highly vascular organ. Reports defining the scope of bleeding in pediatric liver transplants are few. Aims We conducted a retrospective analysis of liver transplants performed at our pediatric tertiary care center to quantify blood loss, blood product utilization, and to determine predictors for massive intraoperative bleeding. Methods Pediatric patients who underwent isolated liver transplantation at Boston Children's Hospital between 2011 and 2016 were included. The amount of blood product transfused in the perioperative period and the incidence of postoperative complications were reported. Univariable and multivariable logistic regressions were used to determine predictors for massive bleeding, defined as estimated blood loss exceeding one circulating blood volume within 24 hours. Results Sixty‐eight children underwent liver transplantation during the study period and were included in the analysis. Multivariable logistic regression analysis identified the following independent predictors of massive bleeding: preoperative hemoglobin level <8.5 g/ dL ( OR 11.09, 95% CI 1.87‐65.76), INR >1.5 ( OR 11.62, 95% CI 2.36‐57.26), platelet count <100 10 9 /L ( OR 7.92, 95% CI 1.46‐43.05), and surgery duration >600 minutes ( OR 6.97, 95% CI 0.99‐48.92). Conclusions Pediatric liver transplantation is associated with substantial blood loss and a significant blood product transfusion burden. A 43% incidence of massive bleeding is reported. Further efforts are needed to improve bleeding management in this high‐risk population.