Balanced blood product transfusion during liver transplantation

Introduction: This study was conducted to determine whether an intra-operative ratio of at least 1:1:2 of fresh frozen plasma (FFP):platelets (PLTs):packed red blood cells (pRBCs) 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:PLTs:pRBCs 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.