Survival rate changes with transfusion of blood products during liver transplantation

  • Luc Massicotte
  • Marie-Pascale Sassine
  • Serge Lenis
  • Robert F. Seal
  • André Roy
General anesthesia



To determine whether red blood cell (RBC) or plasma transfusion is associated with the one-year survival rate variation previously detected in liver transplantation.


A retrospective study of 206 consecutive liver transplantations was undertaken. Intraoperative transfusions of blood products were identified. Twenty-seven variables were studied using univariate and multivariate analyses to identify factors that were associated significantly with survival rate. For analysis of one-year survival, the cases were studied according to the transfused blood products. Patients were stratified according to the degree of RBC and plasma transfusion into four groups: more than four units of RBC, one to four units of RBC, plasma transfusion only, and no plasma or RBC transfusions.


Patients received an average of 2.8 ± 3.5 units of RBC and 4.1 ± 4.1 units of plasma. Thirty-two percent of the patients did not receive any RBC transfusion and 19.4% did not receive any blood products. The one-year survival rate was 81.9% for all patients and 97.4% for patients without any transfusions. Of the 27 variables evaluated, only RBC and plasma transfusions were associated with significant decrease in the one-year survival rate, which was seen in the group who received only plasma (76.9%, P = 0.014) and the group who received more than four units of RBC (62.5%, P < 0.0001).


Although we cannot demonstrate causality, our analysis shows that our one-year survival rate following liver transplantation decreased significantly with the intraoperative transfusion of any amount of plasma or more than four units of RBC.

Le taux de survie change avec la transfusion de produits sanguins pendant la transplantation hépatique



Déterminer si la transfusion de globules rouges (GR) ou de plasma est associée à la variation du taux de survie d’un an déjà détectée pour une transplantation hépatique.


Une étude rétrospective de 206 transplantations hépatiques consécutives a été menée. Les transfusions peropératoires de produits sanguins ont été recensées. Nous avons étudié 27 variables par des d’analyses à une ou plusieurs variables pour repérer les facteurs associés de façon significative au taux de survie. Pour l’analyse du taux de survie d’un an a été faite selon les produits sanguins transfusés. Les patients ont été stratifiés en quatre groupes d’après le degré de transfusion de GR et de plasma: plus de quatre unités de GR, de une à quatre unités, transfusion de plasma seulement et aucune transfusion.


Les patients ont reçu en moyenne 2,8 ± 3,5 unités de GR et 4,1 ± 4,1 unités de plasma. Trente-deux pour cent n’ont reçu aucune transfusion de GRet 19,4% aucun produit sanguin. Le taux de survie d’un an a été de 81,9% pour tous les patients et de 97,4% pour ceux qui n’ont eu aucune transfusion. Des 27 variables évaluées, seules les transfusions de Gr et de plasma ont été associées à une baisse significative du taux de survie d’un an, notée chez les patients qui ont reçu du plasma seulement (76,9%, P = 0,014) ou plus de quatre unités de GR (62,5%, P < 0,0001).


Sans pouvoir établir de causalité, notre analyse montre que le taux de survie d’un an après une transplantation hépatique diminue significativement avec la transfusion peropératoire de toute quantité de plasma ou de plus de quatre unités de GR.


  1. 1.
    Carton EG, Rettke SR, Plevak DJ, Geiger HJ, Kranner PW, Coursin DB. Perioperative care of the liver transplant patient: part 1. Anesth Analg 1994; 78: 120–33.PubMedCrossRefGoogle Scholar
  2. 2.
    Carton EG, Plevak DJ, Kranner PW, Rettke SR, Geiger HJ, Coursin DB. Perioperative care of the liver transplant patient: part 2. Anesth Analg 1994; 78: 382–99.PubMedCrossRefGoogle Scholar
  3. 3.
    Schroeder RA, Johnson LB, Plotkin JS, Kno PC, Klein AS. Total blood transfusion and mortality after orthotopic liver transplantation (Letter). Anesthesiology 1999; 91: 329–30.PubMedCrossRefGoogle Scholar
  4. 4.
    Steib A, Freys G, Lehmann C, Meyer C, Mahoudeau G. Intraoperative blood losses and transfusion requirements during adult liver transplantation remain difficult to predict. Can J Anesth 2001; 48: 1075–9.PubMedCrossRefGoogle Scholar
  5. 5.
    Cacciarelli TV, Keeffe EB, Moore DH, et al. Effect of intraoperative blood transfusion on patient outcome in hepatic transplantation. Arch Surg 1999; 134: 25–9.PubMedCrossRefGoogle Scholar
  6. 6.
    Goodnough LT, Brecher ME, Kanter H, AuBuchon JP. Transfusion medecine — blood transfusion — first of two parts. N Engl J Med 1999; 340: 438–47.PubMedCrossRefGoogle Scholar
  7. 7.
    Goodnough LT, Brecher ME, Kanter H, AuBuchon JP. Transfusion medecine — blood conservation — second of two parts. N Engl J Med 1999; 340: 525–33.PubMedCrossRefGoogle Scholar
  8. 8.
    Spahn DR, Casutt M. Eliminating blood transfusions. New aspects and perspectives. Anesthesiology 2000; 93: 242–55.PubMedCrossRefGoogle Scholar
  9. 9.
    Ramos E, Dalmau A, Sabate A, et al. Intraoperative red blood cell transfusion in liver transplantation: influence on patient outcome, prediction of requirements, and measures to reduce them. Liver Transpl 2003; 9: 1320–7.PubMedCrossRefGoogle Scholar
  10. 10.
    Houvenaeghel M, Lefevre P, Samson D, Dyen J, Limet L, Manelli JC. Autologous transfusion by perioperative salvage in orthotopic transplantation of the liver (French). Ann Fr Anesth Reanim 1989; 8: 326–33.PubMedGoogle Scholar
  11. 11.
    Findlay JY, Rettle SR, Ereth MH, Plevak DJ, Krom RA, Kufner RP. Aprotinin reduces red blood cell transfusion in orthotopic liver transplantation: a prospective, randomized, double-blind study. Liver Transpl 2001; 7: 802–7.PubMedCrossRefGoogle Scholar
  12. 12.
    Edwards EB, Roberts JP, McBride MA, Schulak JA, Hunsicker LG. The effect of the volume of procedures at transplantation centers on mortality after liver transplantation. N Engl J Med 1999; 341: 2049–53.PubMedCrossRefGoogle Scholar
  13. 13.
    Trotter JF, Wachs M, Evenson GT, Kam I. Adult-to-adult transplantation of the right hepatic lobe from a living donor. N Engl J Med 2002; 346: 1974–82.CrossRefGoogle Scholar
  14. 14.
    O’Grady JG, Burroughs A, Hardy P, Elbourne D, Truesdale A; and the UK and Republic or Ireland Liver Transplant Study Group. Tacrolimus versus microemulsified ciclosporin in liver transplantation: the TMC randomised controlled trial. Lancet 2002; 360: 1119–25.PubMedCrossRefGoogle Scholar
  15. 15.
    Comparative statistics for Québec (December 31st) [cited 8 July 2004]. Available from URL: Scholar
  16. 16.
    Deschênes M, Villeneuve JP, Dagenais M, et al. Lack of relationship between preoperative measures of the severity of cirrhosis and short-term survival after liver transplantation. Liver Transpl Surg 1997; 3: 532–7.PubMedCrossRefGoogle Scholar
  17. 17.
    van de Watering LM, Hermans J, Houbiers G A, et al. Beneficial effects of leukocyte depletion of transfused blood on postoperative complications in patients undergoing cardiac surgery. Circulation 1998; 97: 562–8.PubMedGoogle Scholar
  18. 18.
    Moore FA, Moore EE, Sauaia A. Blood transfusion. An independent risk factor for postinjury multiple organ failure. Arch Surg 1997; 132: 620–5.PubMedGoogle Scholar
  19. 19.
    Murphy PJ, Connery C, Hicks GL Jr,Blumberg N. Homologous blood transfusion as a risk factor for postoperative infection after coronary artery bypass graft operations. J Thorac Cardiovasc Surg 1992; 104: 1092–9.PubMedGoogle Scholar
  20. 20.
    Maetani S, Nishikawa T, Hirakawa A, Tobe T. Role of blood transfusion in organ system failure following major abdominal surgery. Ann Surg 1986; 203: 275–81.PubMedCrossRefGoogle Scholar
  21. 21.
    Vamvakas EC, Carven JH. Exposure to allogeneic plasma and risk of postoperative pneumonia and/or wound infection in coronary artery bypass graft surgery. Transfusion 2002; 42: 107–13.PubMedCrossRefGoogle Scholar
  22. 22.
    Hill AB. Principles of Medical Statistics, 9th ed. New-York: Oxford University Press; 1971: 309.Google Scholar

Copyright information

© Canadian Anesthesiologists 2005

Authors and Affiliations

  • Luc Massicotte
    • 1
  • Marie-Pascale Sassine
    • 1
  • Serge Lenis
    • 1
  • Robert F. Seal
    • 3
  • André Roy
    • 2
  1. 1.From the Departments of AnesthesiologyHôpital St-Luc — CHUMMontréalCanada
  2. 2.From the Departments of Anesthesiology and SurgeryCentre Hospitalier de l’Université de Montréal (CHUM)Montréal
  3. 3.and the Department of Anesthesiology and Pain MedicineUniversity of AlbertaEdmontonCanada

Personalised recommendations