Patterns of Blood Product Utilisation in Orthotopic Liver Transplantation in a Tertiary Hospital

Background: Transfusion requirements in orthotopic liver transplantation (OLT)have reduced dramatically over the last two decades. Minimising bleeding and reducing unnecessary transfusions are key goals in the perioperative period. Advances in surgical and anaesthetic techniques including point of care testing have all contributed to a decline in allogeneic blood product use. There are limited studies that have shown a change in use of blood and blood products in OLT patients. Aims: The aim of the study was to examine the changing trends in blood product use in orthotopic liver transplantation (OLT) patients over the years Methods: A retrospective study of patients undergoing OLT at Flinders Medical Centre between 2003 and 2014 was conducted. Over the 12 year period there was no change in number of male patients or patient’s age or MELD score. OLT patient details were extracted from the liver transplant database, patient demographics and morbidity from the hospital database and blood product use from the transfusion laboratory information system Results: While there was no change in RBC transfusion rates, a high proportion(80%) of OLT patients received FFP at the start of the study period compared to only28% in 2014 (P < 0.001) with a significant fall in the number of FFP units transfused from a median of 4 (2–5) in 2003 to 0 (0–1.5) in 2014 (P < 0.001). There was negligible use of cryoprecipitate between 2003 and 2007. However, the median dose of cryoprecipitate gradually increased to reach a peak in 2012, median of 4 doses(IQR 1.5–7) and subsequently dropped to a median of 2 doses in 2014 (P < 0.001).The proportion of patients receiving platelets initially started to increase from 2006(69.2% of patients) and reached a peak in 2010 (85%) and remained stable until2013 followed by a drop in 2014 (56%) (P < 0.008). The median volume of intraoperatively scavenged RBC reinfused in 2014 was 477 ml (240–736 ml) compared to a median of 1330 ml (778–2855 ml) in 2003 (P < 0.001). Summary/Conclusions: The single centre analysis shows a large reduction in FFP and an increase in use of platelets and cryoprecipitate over a 12 year period. This reduction has been associated with reduced intraoperative crystalloid use, but more importantly with the routine use of intra-operative viscoelastic assays to manage coagulopathy and guide appropriate transfusion practice during PLT.