The effects of intraoperative cryoprecipitate transfusion on acute renal failure following orthotropic liver transplantation
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The definition of risk factors associated with acute renal failure (ARF) following orthotropic liver transplantation (OLT) is still controversial. Cryoprecipitate, which can supply fibrinogen and other coagulation factors, is widely used in OLT. However, the effects of intraoperative cryoprecipitate transfusion on ARF following OLT remain unclear.
In a series of 389 adult patients who received grafts from deceased donors and underwent their first OLT, the clinical correlation between intraoperative cryoprecipitate transfusion and ARF following OLT was retrospectively studied after adjusting for potential confounders. The distribution of ARF and the causes of death within the first year after OLT were also compared separately in patients with and without cryoprecipitate transfusion.
The incidence of ARF in patients with cryoprecipitate transfusion was significantly higher than in patients without cryoprecipitate transfusion (15.9 vs. 7.8 %, p = 0.012). A nonlinear relationship between intraoperative cryoprecipitate transfusion and ARF following OLT was observed. The risk of ARF increased with the cryoprecipitate transfusion level up to the turning point (16 U) (adjusted OR 1.1, 95 % CI 1.1–1.2; p < 0.001). When the cryoprecipitate level exceeded 16 U, the level of cryoprecipitate transfusion was not associated with the risk of ARF (OR 0.95, 95 % CI 0.85–1.1; p = 0.319). Deaths within the first year after the operation occurred more frequently in cases with cryoprecipitate transfusion (22.9 vs. 14.2 %, p = 0.029).
These findings suggested that intraoperative cryoprecipitate transfusion is associated with ARF following OLT. Cryoprecipitate transfusion during OLT should be performed carefully until more convincing evidence has been found.
KeywordsTransfusion Cryoprecipitate Acute renal failure Liver transplantation
We gratefully acknowledge Prof. Changzhong Chen from Harvard Medical School for the assistance with statistics. This work was supported by a grant from the National Natural Science Foundation of China (81170445).
Conflict of interest
Shuang Liu, Xiaoliang Wang, Yuanshan Lu, Tao Li, Zijun Gong, Tao Sheng, Bin Hu, Zhihai Peng and Xing Sun declare that they have no conflicts of interest.
Compliance with Ethics Requirements
All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2008. Due to the retrospective nature of the study, this article did not involve any studies with human or animal subjects. National legislation and the ethics committee of Shanghai First People’s Hospital approved this retrospective study.
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