Liver transplant surgery is often associated with considerable bleeding. This study was undertaken to analyse the average blood component consumption and the effectiveness of preoperative laboratory assessment and Model For End Stage Liver Disease (MELD) score in the estimation of transfusion requirements in Living Donor Liver Transplantation (LDLT).
Transfusion Medicine support in live related combined liver and kidney transp...Apollo Hospitals
Combined liver and kidney transplantation (CLKT) is the procedure of choice for patients with dual-organ failure. Transfusion Medicine support in live related combined liver and kidney transplantation (CLKT) not only involves the provision of safest possible blood and histocompatibility testing (HLA typing & CDC Crossmatch) but also ensures better patient care due to availability of various advance immunohematological techniques in a time bound frame. A fully equipped functional and sophisticated blood bank and HLA lab is a must in the hospitals where such surgeries are done.
Mr. Markandeya Rajuponnada, a 42-year-old male, had several abnormal hematological results from a CBC test including low hemoglobin, hematocrit, RBC count, and high RDW, TLC count, and neutrophil percentage. The results indicate anemia and possible infection or inflammation. Most of his cell counts and percentages were outside of the normal reference intervals provided. His medical records should be reviewed to understand these abnormal blood test results and correlate with his clinical condition.
This document discusses patient blood management (PBM), which is a multidisciplinary approach to optimizing patient care and reducing unnecessary blood transfusions. It has three pillars: optimizing erythropoiesis, minimizing bleeding, and harnessing physiological reserves of anemia. The evidence shows PBM can reduce transfusions by 39% without increasing risks. It has led to reduced transfusions and costs in various settings like cardiac and orthopedic surgery. PBM programs require a multidisciplinary team approach led by specialties like anesthesiology. Overall, PBM provides better patient outcomes while reducing allogeneic blood use.
Does Serum Lactate and Central Venous Saturation Predict Perioperative Outcom...crimsonpublishersOJCHD
Off-pump coronary artery bypass grafting (OP-CABG) surgery without the use of cardiopulmonary bypass (CPB) has come into practice for surgical treatment of Coronary artery disease (CAD) to reduce the post-operative systemic inflammatory response and post-operative morbidity. However, manipulation of the beating heart during OP-CABG surgery brings significant fluctuations in the patients haemodynamics leading to occult hypo-perfusion and 'Global tissue hypoxia' (GTH) -a decrease in oxygen utilization associated with anaerobic metabolism.
This document provides clinical practice guidelines for blood conservation strategies in cardiac surgery from the Society of Thoracic Surgeons and The Society of Cardiovascular Anesthesiologists. It recommends various preoperative, intraoperative, and postoperative interventions to reduce bleeding and blood transfusions during cardiac procedures. These include discontinuing antiplatelet agents preoperatively, using antifibrinolytics intraoperatively, and employing blood salvage techniques. The guidelines provide evidence and recommendations for different blood derivative products and perfusion strategies to optimize blood conservation.
Transfusion Medicine support in live related combined liver and kidney transp...Apollo Hospitals
Combined liver and kidney transplantation (CLKT) is the procedure of choice for patients with dual-organ failure. Transfusion Medicine support in live related combined liver and kidney transplantation (CLKT) not only involves the provision of safest possible blood and histocompatibility testing (HLA typing & CDC Crossmatch) but also ensures better patient care due to availability of various advance immunohematological techniques in a time bound frame. A fully equipped functional and sophisticated blood bank and HLA lab is a must in the hospitals where such surgeries are done.
Mr. Markandeya Rajuponnada, a 42-year-old male, had several abnormal hematological results from a CBC test including low hemoglobin, hematocrit, RBC count, and high RDW, TLC count, and neutrophil percentage. The results indicate anemia and possible infection or inflammation. Most of his cell counts and percentages were outside of the normal reference intervals provided. His medical records should be reviewed to understand these abnormal blood test results and correlate with his clinical condition.
This document discusses patient blood management (PBM), which is a multidisciplinary approach to optimizing patient care and reducing unnecessary blood transfusions. It has three pillars: optimizing erythropoiesis, minimizing bleeding, and harnessing physiological reserves of anemia. The evidence shows PBM can reduce transfusions by 39% without increasing risks. It has led to reduced transfusions and costs in various settings like cardiac and orthopedic surgery. PBM programs require a multidisciplinary team approach led by specialties like anesthesiology. Overall, PBM provides better patient outcomes while reducing allogeneic blood use.
Does Serum Lactate and Central Venous Saturation Predict Perioperative Outcom...crimsonpublishersOJCHD
Off-pump coronary artery bypass grafting (OP-CABG) surgery without the use of cardiopulmonary bypass (CPB) has come into practice for surgical treatment of Coronary artery disease (CAD) to reduce the post-operative systemic inflammatory response and post-operative morbidity. However, manipulation of the beating heart during OP-CABG surgery brings significant fluctuations in the patients haemodynamics leading to occult hypo-perfusion and 'Global tissue hypoxia' (GTH) -a decrease in oxygen utilization associated with anaerobic metabolism.
This document provides clinical practice guidelines for blood conservation strategies in cardiac surgery from the Society of Thoracic Surgeons and The Society of Cardiovascular Anesthesiologists. It recommends various preoperative, intraoperative, and postoperative interventions to reduce bleeding and blood transfusions during cardiac procedures. These include discontinuing antiplatelet agents preoperatively, using antifibrinolytics intraoperatively, and employing blood salvage techniques. The guidelines provide evidence and recommendations for different blood derivative products and perfusion strategies to optimize blood conservation.
Antibiotic dose modification is crucial on patients with CRRT with sepsis and MOF. This talk highlights the importance of achieving plasma therapeutic drug concentration in ICU patients to enhance their chances of survival while on CRRT
Lactate as mortality predictor in cirrhosis / ACLFAjay Kandpal
Lactate levels provide additional prognostic value beyond existing scoring systems for predicting mortality in critically ill cirrhotic patients. A multinational study assessed lactate levels and lactate clearance in 584 ICU patients with cirrhosis. Lactate levels on admission were associated with increased short and long-term mortality. The study derived a modified CLIF-C ACLF score incorporating lactate (CLIF-C ACLFsLact) that showed improved discrimination for predicting 28-day, 90-day, and 1-year mortality compared to the original CLIF-C ACLF score or MELD score. The CLIF-C ACLFsLact also showed better prediction of mortality in a validation cohort of 250 patients.
The document summarizes guidelines from the 2011 update to the Society of Thoracic Surgeons and the Society of Cardiovascular Anesthesiologists blood conservation clinical practice guidelines. It discusses recommendations for various preoperative, intraoperative, and postoperative interventions to reduce blood loss and transfusions during cardiac procedures. The guidelines classify recommendations into different evidence-based classes and assign levels of evidence. Areas addressed include management of antiplatelet drugs, use of blood derivatives, minimally invasive procedures, blood salvage techniques, and creation of multidisciplinary blood management teams.
(1) Studies supporting massive transfusion protocols using fixed plasma to red blood cell ratios have significant survivor bias that neglect differences in patient severity. (2) Patients who received higher plasma ratios were less severely injured and coagulopathic on presentation. (3) Using point-of-care coagulation monitoring allows for a goal-directed, individualized approach to plasma transfusion that reduces unnecessary plasma use and risk of complications compared to fixed ratio strategies.
Anaesthesia for Living Donor Combined Liver Kidney TransplantationApollo Hospitals
Orthotopic liver transplantation is now the best therapeutic option for patients with chronic liver failure [1]. Liver transplant is now a routine surgery performed in numerous medical centers throughout the world. Till now about 600 liver transplants have been performed in the Indraprastha Apollo Hospital, New Delhi. Combined liver kidney transplantation (CKLT) is the treatment for end-stage liver and kidney diseases. Combined liver kidney transplantation from living donors is performed in very few centers. Not many cases of Living donor combined Liver Kidney transplantation has been described in the literature. Here we report the clinical experience of our first living donor combined liver kidney transplantation (kidney after liver) in patient with end-stage liver disease (ESLD) and end stage renal failure (ESRD). Liver and kidney graft has been harvested from two living related donors.
Peritoneal dialysis (PD) is associated with better preservation of residual kidney function compared to hemodialysis (HD). PD also has advantages such as lower infection risks and improved quality of life through increased employment rates and lifestyle flexibility compared to HD. However, PD remains underutilized in many countries despite its benefits. Factors contributing to underutilization include modality preferences of nephrologists, lack of patient education, and system-related barriers. Integrated care approaches emphasizing early referral and shared modality decision-making between patients and nephrologists are optimal for end-stage renal disease treatment.
This study analyzed plasma levels of antithrombin-III (AT-III) and serum aminotransferase activity in 60 participants, including 20 with chronic hepatitis, 20 with cirrhosis, and 20 healthy controls. The study found that AT-III levels and aminotransferase activity were significantly different between the patient groups and controls. Specifically, patients with cirrhosis had significantly lower AT-III levels than those with chronic hepatitis. The study concludes that plasma AT-III levels may be a useful non-invasive marker for diagnosing cirrhosis in patients with chronic liver disease.
Multicenter prospective study in several Spaniard hospital
Anemia and iron deficit in preoperative study
Presented at NATA meeting at Dublin, April 2016
This document discusses cold machine perfusion versus static cold storage for preserving kidneys from standard criteria, extended criteria, and donation after cardiac death donors for transplantation. It summarizes the incidence and impact of delayed graft function, outlines kidney preservation methods and clinical trials comparing outcomes between cold storage and machine perfusion. It identifies unanswered questions around how preservation method may differentially impact outcomes based on donor and recipient risk factors.
This document discusses dialytic support for patients with acute kidney injury (AKI). It begins by outlining classifications and definitions of AKI severity. It then addresses many open questions regarding renal replacement therapy (RRT) for AKI, such as when to start, what modality to use, and when to stop. The document reviews various RRT modalities and considerations for their use. It provides guidelines on determining when to initiate RRT based on lab values and clinical criteria. Overall, the document aims to help clinicians navigate the many decisions that must be made in providing RRT for AKI patients.
Blood transfusion involves the therapeutic use of whole blood or its components like red blood cells and platelets. Careful donor selection and testing is required to ensure a safe blood supply. Blood transfusion can be life-saving for clinical treatments but is a limited resource, so hospitals must focus on appropriate use. Key priorities include avoiding unnecessary transfusions and reducing errors. A robust clinical governance structure is essential for implementing safe transfusion practices and appropriate blood use.
The document discusses acute normovolemic hemodilution (ANH), a blood saving technique where blood is removed and replaced with fluids to dilute the blood volume. The authors conducted a study comparing ANH patients monitored with the Vigileo system to a control group. Both groups underwent ANH for hip surgery. The Vigileo system continuously monitored cardiac output, stroke volume variation, and other parameters to ensure hemodynamic stability during ANH. Results showed hematocrit and oxygen delivery dropped as expected with ANH but remained within safe limits. No complications occurred, suggesting ANH can be performed safely when carefully monitored with Vigileo.
Automated hplc screening of newborns for sickle cell anemia juarez1precioso
This document describes an automated HPLC method used to screen over 2.5 million newborn dried blood samples for hemoglobinopathies like sickle cell anemia. The method uses cation exchange chromatography to separate and quantify hemoglobins F, A, S, C, E, and D. It was found to have high throughput of 1 sample per minute, small sample volume needs, precision of variant quantification within 14-18%, and detection limits of 0.5% for Hb S and C and 1.0% for other variants. Shortcomings included the need for manual sample loading and lack of sample identification barcodes. The method was shown to accurately detect cases of sickle cell disease in newborns over 4 years of
Data mining visualization to support biochemical markers for liver fibrosis i...Waqas Tariq
The reference diagnostic test to detect fibrosis is liver biopsy (LB), a procedure subject to various limitations, including risk of patient injury and sampling error. FibroTest (FT) and ActiTest (AT) are biochemical markers (noninvasive tests) used in determining the level of fibrosis and the degree of necroinflammatory activity in the liver. The objective of this work is to discover the differences in the temporal patterns between noninvasive tests and liver biopsy by visualization tools, which made it easier to understand the relations of the complicated rules. This Study ware focused on the major serum fibrosis markers (FT/AT). The test uses a combination of serum biochemical markers with visualization technique to evaluate whether biochemical markers can be used to estimate the stage of liver fibrosis and necro-inflammatory activity in the liver.
The early results of 363 donor operations in Central Oil Worker's Hospital, A...Kamran Beydullayev
The document summarizes the experience of the first transplantation center founded in Azerbaijan in 2009. It provides data on the center's liver and kidney transplant operations from 2009-2016. Specifically, it discusses outcomes for 90 living donor liver transplants performed between 2009-2016. It found that all 90 donors survived without major complications, with only 3 requiring blood transfusions. It also provides statistics on 273 kidney transplants performed from 2010-2016, noting surgical techniques and outcomes for donors were successful with no major complications.
Crimson Publishers: Safety of Everolimus in Living Donor Liver Transplantatio...CrimsonGastroenterology
The document discusses the use of everolimus (EVR) as an immunosuppressive drug for liver transplant recipients with severe renal dysfunction. It summarizes a study that found that switching from calcineurin inhibitors to EVR plus reduced tacrolimus led to improved renal function in 66.6% of recipients with pre-transplant estimated GFR below 30 mL/min/1.73m2. The study also found the EVR-based regimen was well tolerated with no significant safety concerns. The conclusion is that EVR-based immunosuppression can improve kidney function in patients with severe pre-transplant renal insufficiency.
This document provides clinical practice guidelines for vascular access for haemodialysis. It includes 8 sections that make recommendations on various aspects of vascular access based on a literature review up to March 2015. The guidelines recommend arteriovenous fistula as the preferred type of access, followed by arteriovenous graft and catheter. They provide guidance on vessel assessment, timing of access placement, maintenance and monitoring of access, and prevention of infections. The overarching goal is to minimize catheter use and promote native vascular access for long-term hemodialysis.
Background: Resectability Criteria for Colorectal Liver Metastases (CRLM) have expanded, and advances in liver surgery have increased the number of patients eligible for resection. Identifying risk factors for early recurrence to help stratify CRLM patients will contribute to targeted management of these patients, including surveillance follow-up.Objectives: To identify risk factors for early recurrence post-resection for CRLM in a contemporary cohort of patients. Early recurrence was defi ned based on unit protocol as evidence of recurrent disease on follow-up imaging within one year of surgery.Methods: From January 2012 to December 2016, 133 patients with CRLM underwent liver resection in our Unit; 115 patients followed up for at least a year were eligible. We analysed pre-operative variables (sex, age, BMI, comorbidities, CEA and Liver function tests (LFTs), lesion number, size of largest liver lesion, neoadjuvant chemotherapy), operative variables (anatomical vs non-anatomical, major vs minor, redo liver surgery, concomitant use of ablation techniques, blood loss, blood transfusions, Pringle’s manoeuvre), and post-operative variables (complications, length of hospital stay, histological parameters) were analysed.
This document discusses renal replacement therapy for acute kidney injury (AKI) in intensive care unit patients. It defines AKI and its prevalence in ICU patients. It describes the various modes of renal replacement therapy including intermittent hemodialysis, continuous renal replacement therapy and peritoneal dialysis. It discusses indications for starting renal replacement therapy and debates the optimal timing, modality and dosing of therapy. While several studies have examined these issues, the document concludes that the choice of renal replacement therapy should be individualized for each critically ill patient based on their condition and available resources.
Platelet function and constituents of platelet rich plasma.Angad Malhotra
Int J Sports Med. 2013 Jan;34(1):74-80. doi: 10.1055/s-0032-1316319. Epub 2012 Aug 14.
Platelet function and constituents of platelet rich plasma.
Pelletier MH, Malhotra A, Brighton T, Walsh WR, Lindeman R.
Antibiotic dose modification is crucial on patients with CRRT with sepsis and MOF. This talk highlights the importance of achieving plasma therapeutic drug concentration in ICU patients to enhance their chances of survival while on CRRT
Lactate as mortality predictor in cirrhosis / ACLFAjay Kandpal
Lactate levels provide additional prognostic value beyond existing scoring systems for predicting mortality in critically ill cirrhotic patients. A multinational study assessed lactate levels and lactate clearance in 584 ICU patients with cirrhosis. Lactate levels on admission were associated with increased short and long-term mortality. The study derived a modified CLIF-C ACLF score incorporating lactate (CLIF-C ACLFsLact) that showed improved discrimination for predicting 28-day, 90-day, and 1-year mortality compared to the original CLIF-C ACLF score or MELD score. The CLIF-C ACLFsLact also showed better prediction of mortality in a validation cohort of 250 patients.
The document summarizes guidelines from the 2011 update to the Society of Thoracic Surgeons and the Society of Cardiovascular Anesthesiologists blood conservation clinical practice guidelines. It discusses recommendations for various preoperative, intraoperative, and postoperative interventions to reduce blood loss and transfusions during cardiac procedures. The guidelines classify recommendations into different evidence-based classes and assign levels of evidence. Areas addressed include management of antiplatelet drugs, use of blood derivatives, minimally invasive procedures, blood salvage techniques, and creation of multidisciplinary blood management teams.
(1) Studies supporting massive transfusion protocols using fixed plasma to red blood cell ratios have significant survivor bias that neglect differences in patient severity. (2) Patients who received higher plasma ratios were less severely injured and coagulopathic on presentation. (3) Using point-of-care coagulation monitoring allows for a goal-directed, individualized approach to plasma transfusion that reduces unnecessary plasma use and risk of complications compared to fixed ratio strategies.
Anaesthesia for Living Donor Combined Liver Kidney TransplantationApollo Hospitals
Orthotopic liver transplantation is now the best therapeutic option for patients with chronic liver failure [1]. Liver transplant is now a routine surgery performed in numerous medical centers throughout the world. Till now about 600 liver transplants have been performed in the Indraprastha Apollo Hospital, New Delhi. Combined liver kidney transplantation (CKLT) is the treatment for end-stage liver and kidney diseases. Combined liver kidney transplantation from living donors is performed in very few centers. Not many cases of Living donor combined Liver Kidney transplantation has been described in the literature. Here we report the clinical experience of our first living donor combined liver kidney transplantation (kidney after liver) in patient with end-stage liver disease (ESLD) and end stage renal failure (ESRD). Liver and kidney graft has been harvested from two living related donors.
Peritoneal dialysis (PD) is associated with better preservation of residual kidney function compared to hemodialysis (HD). PD also has advantages such as lower infection risks and improved quality of life through increased employment rates and lifestyle flexibility compared to HD. However, PD remains underutilized in many countries despite its benefits. Factors contributing to underutilization include modality preferences of nephrologists, lack of patient education, and system-related barriers. Integrated care approaches emphasizing early referral and shared modality decision-making between patients and nephrologists are optimal for end-stage renal disease treatment.
This study analyzed plasma levels of antithrombin-III (AT-III) and serum aminotransferase activity in 60 participants, including 20 with chronic hepatitis, 20 with cirrhosis, and 20 healthy controls. The study found that AT-III levels and aminotransferase activity were significantly different between the patient groups and controls. Specifically, patients with cirrhosis had significantly lower AT-III levels than those with chronic hepatitis. The study concludes that plasma AT-III levels may be a useful non-invasive marker for diagnosing cirrhosis in patients with chronic liver disease.
Multicenter prospective study in several Spaniard hospital
Anemia and iron deficit in preoperative study
Presented at NATA meeting at Dublin, April 2016
This document discusses cold machine perfusion versus static cold storage for preserving kidneys from standard criteria, extended criteria, and donation after cardiac death donors for transplantation. It summarizes the incidence and impact of delayed graft function, outlines kidney preservation methods and clinical trials comparing outcomes between cold storage and machine perfusion. It identifies unanswered questions around how preservation method may differentially impact outcomes based on donor and recipient risk factors.
This document discusses dialytic support for patients with acute kidney injury (AKI). It begins by outlining classifications and definitions of AKI severity. It then addresses many open questions regarding renal replacement therapy (RRT) for AKI, such as when to start, what modality to use, and when to stop. The document reviews various RRT modalities and considerations for their use. It provides guidelines on determining when to initiate RRT based on lab values and clinical criteria. Overall, the document aims to help clinicians navigate the many decisions that must be made in providing RRT for AKI patients.
Blood transfusion involves the therapeutic use of whole blood or its components like red blood cells and platelets. Careful donor selection and testing is required to ensure a safe blood supply. Blood transfusion can be life-saving for clinical treatments but is a limited resource, so hospitals must focus on appropriate use. Key priorities include avoiding unnecessary transfusions and reducing errors. A robust clinical governance structure is essential for implementing safe transfusion practices and appropriate blood use.
The document discusses acute normovolemic hemodilution (ANH), a blood saving technique where blood is removed and replaced with fluids to dilute the blood volume. The authors conducted a study comparing ANH patients monitored with the Vigileo system to a control group. Both groups underwent ANH for hip surgery. The Vigileo system continuously monitored cardiac output, stroke volume variation, and other parameters to ensure hemodynamic stability during ANH. Results showed hematocrit and oxygen delivery dropped as expected with ANH but remained within safe limits. No complications occurred, suggesting ANH can be performed safely when carefully monitored with Vigileo.
Automated hplc screening of newborns for sickle cell anemia juarez1precioso
This document describes an automated HPLC method used to screen over 2.5 million newborn dried blood samples for hemoglobinopathies like sickle cell anemia. The method uses cation exchange chromatography to separate and quantify hemoglobins F, A, S, C, E, and D. It was found to have high throughput of 1 sample per minute, small sample volume needs, precision of variant quantification within 14-18%, and detection limits of 0.5% for Hb S and C and 1.0% for other variants. Shortcomings included the need for manual sample loading and lack of sample identification barcodes. The method was shown to accurately detect cases of sickle cell disease in newborns over 4 years of
Data mining visualization to support biochemical markers for liver fibrosis i...Waqas Tariq
The reference diagnostic test to detect fibrosis is liver biopsy (LB), a procedure subject to various limitations, including risk of patient injury and sampling error. FibroTest (FT) and ActiTest (AT) are biochemical markers (noninvasive tests) used in determining the level of fibrosis and the degree of necroinflammatory activity in the liver. The objective of this work is to discover the differences in the temporal patterns between noninvasive tests and liver biopsy by visualization tools, which made it easier to understand the relations of the complicated rules. This Study ware focused on the major serum fibrosis markers (FT/AT). The test uses a combination of serum biochemical markers with visualization technique to evaluate whether biochemical markers can be used to estimate the stage of liver fibrosis and necro-inflammatory activity in the liver.
The early results of 363 donor operations in Central Oil Worker's Hospital, A...Kamran Beydullayev
The document summarizes the experience of the first transplantation center founded in Azerbaijan in 2009. It provides data on the center's liver and kidney transplant operations from 2009-2016. Specifically, it discusses outcomes for 90 living donor liver transplants performed between 2009-2016. It found that all 90 donors survived without major complications, with only 3 requiring blood transfusions. It also provides statistics on 273 kidney transplants performed from 2010-2016, noting surgical techniques and outcomes for donors were successful with no major complications.
Crimson Publishers: Safety of Everolimus in Living Donor Liver Transplantatio...CrimsonGastroenterology
The document discusses the use of everolimus (EVR) as an immunosuppressive drug for liver transplant recipients with severe renal dysfunction. It summarizes a study that found that switching from calcineurin inhibitors to EVR plus reduced tacrolimus led to improved renal function in 66.6% of recipients with pre-transplant estimated GFR below 30 mL/min/1.73m2. The study also found the EVR-based regimen was well tolerated with no significant safety concerns. The conclusion is that EVR-based immunosuppression can improve kidney function in patients with severe pre-transplant renal insufficiency.
This document provides clinical practice guidelines for vascular access for haemodialysis. It includes 8 sections that make recommendations on various aspects of vascular access based on a literature review up to March 2015. The guidelines recommend arteriovenous fistula as the preferred type of access, followed by arteriovenous graft and catheter. They provide guidance on vessel assessment, timing of access placement, maintenance and monitoring of access, and prevention of infections. The overarching goal is to minimize catheter use and promote native vascular access for long-term hemodialysis.
Background: Resectability Criteria for Colorectal Liver Metastases (CRLM) have expanded, and advances in liver surgery have increased the number of patients eligible for resection. Identifying risk factors for early recurrence to help stratify CRLM patients will contribute to targeted management of these patients, including surveillance follow-up.Objectives: To identify risk factors for early recurrence post-resection for CRLM in a contemporary cohort of patients. Early recurrence was defi ned based on unit protocol as evidence of recurrent disease on follow-up imaging within one year of surgery.Methods: From January 2012 to December 2016, 133 patients with CRLM underwent liver resection in our Unit; 115 patients followed up for at least a year were eligible. We analysed pre-operative variables (sex, age, BMI, comorbidities, CEA and Liver function tests (LFTs), lesion number, size of largest liver lesion, neoadjuvant chemotherapy), operative variables (anatomical vs non-anatomical, major vs minor, redo liver surgery, concomitant use of ablation techniques, blood loss, blood transfusions, Pringle’s manoeuvre), and post-operative variables (complications, length of hospital stay, histological parameters) were analysed.
This document discusses renal replacement therapy for acute kidney injury (AKI) in intensive care unit patients. It defines AKI and its prevalence in ICU patients. It describes the various modes of renal replacement therapy including intermittent hemodialysis, continuous renal replacement therapy and peritoneal dialysis. It discusses indications for starting renal replacement therapy and debates the optimal timing, modality and dosing of therapy. While several studies have examined these issues, the document concludes that the choice of renal replacement therapy should be individualized for each critically ill patient based on their condition and available resources.
Similar to Transfusion requirements in living donor liver transplantation e Role of laboratory assessment and Model For End Stage Liver Disease (MELD) score
Platelet function and constituents of platelet rich plasma.Angad Malhotra
Int J Sports Med. 2013 Jan;34(1):74-80. doi: 10.1055/s-0032-1316319. Epub 2012 Aug 14.
Platelet function and constituents of platelet rich plasma.
Pelletier MH, Malhotra A, Brighton T, Walsh WR, Lindeman R.
This document discusses using intrathoracic impedance measures from implantable cardiac devices to monitor changes in intravascular fluid volume during volume reduction therapy for heart failure patients. It found that two impedance vectors, between the right atrial ring to left ventricular ring and the left ventricular ring to right ventricular ring, were most closely associated with changes in plasma volume as measured by hematocrit levels. Monitoring these specific impedance vectors may help more accurately guide volume reduction therapy by tracking changes in the intravascular fluid compartment.
This study analyzed 96 renal transplant patients to evaluate aortic stiffness and its relationship to renal function. The study found:
1) Aortic pulse wave velocity (APWV), a measure of aortic stiffness, was inversely correlated with estimated glomerular filtration rate (eGFR), a measure of renal function - the poorer the renal function, the higher the aortic stiffness.
2) APWV increased with more advanced stages of chronic kidney disease (CKD), based on eGFR levels.
3) APWV was positively correlated with blood pressure levels.
The study concludes that aortic stiffness, as measured by APWV, is related to renal graft dysfunction as reflected by decreased e
New System for Chronic Renal Failure Compensation Based on the Symbiotic Hemofiltration by Yumatov EA* in Experimental Techniques in Urology & Nephrology
This study examined the relationship between volume overhydration and endothelial dysfunction in 81 stable patients on continuous ambulatory peritoneal dialysis. Volume status was assessed by normalized extracellular water and endothelial function was estimated by flow-mediated dilation of the brachial artery. There was an independent correlation between the index of volume status (normalized extracellular water) and endothelial function (flow-mediated dilation), with higher normalized extracellular water related to worse endothelial function. Multiple regression analysis identified calcium-phosphate product, normalized extracellular water, and dialysis vintage as independent determinants of endothelial function. The results suggest that volume overhydration may lead to increased cardiovascular risk in dialysis patients through its effects on endothelial dysfunction.
This document provides an overview of thromboelastography (TEG) and rotational thromboelastometry (ROTEM), which are point-of-care viscoelastic tests that analyze whole blood clotting in real time. The document discusses how TEG and ROTEM can provide clinically useful information on coagulation compared to traditional tests. It reviews evidence that TEG- and ROTEM-guided transfusion protocols may decrease transfusions in various specialties like cardiac surgery, trauma, obstetrics, and liver transplantation, though more research is still needed on patient outcomes. The document concludes that TEG and ROTEM are increasingly used to manage coagulopathic bleeding, but that outcome data continues to evolve.
This study analyzed transfusion practices over 5 years at SAQR Hospital in Ras Al Khaimah, UAE. A total of 7,045 blood units were transfused, with the highest use in surgical wards (33%), followed by road traffic accident victims (27%). The most common indications for transfusion were injuries from road traffic accidents, orthopedic surgeries, and cardiovascular surgeries. UAE nationals received the most transfusions, and the most common blood group was O positive. The majority of transfused blood products were packed red blood cells. The study concludes that regular assessment of blood usage and education sessions for clinicians could help ensure blood is used effectively for life-threatening situations.
Renal resistive index (RI) analysis using Doppler ultrasonography has been shown to reflect renal injury in both clinical and animal studies. There are currently two methods for measuring renal RI in mouse models: intrarenal RI and suprarenal RI. Intrarenal RI involves identifying targeted intrarenal arteries within the kidney and measuring blood flow velocities, while suprarenal RI measures flow velocities at the entrance of the suprarenal artery. Suprarenal RI may be more repeatable and comparable between mice since the measurement site is consistent, and it has been associated with renal injury in diet-induced mouse models. However, more research is needed to validate the efficacy and accuracy of suprarenal RI in different animal models.
1. In patients with critical bleeding requiring massive transfusion, institutions should develop massive transfusion protocols that include guidelines for the dose, timing, and ratios of blood component transfusions.
2. Key parameters that should be measured early and frequently include temperature, acid-base status, calcium, hemoglobin, platelet count, coagulation factors, and fibrinogen level.
3. While specific transfusion ratios are uncertain, suggested doses of blood components in massive transfusion are 15 mL/kg of fresh frozen plasma, one adult therapeutic dose of platelets, and 3-4 grams of cryoprecipitate.
1) The study investigated the association between preoperative levels of EPA, DHA, and AA in plasma and red blood cells, and changes in inflammatory markers after open heart surgery.
2) They found the postoperative concentrations of TNF-β decreased and hs-CRP, IL-6, IL-8, IL-18, and IL-10 increased compared to preoperative levels.
3) Preoperative EPA and AA levels were associated with changes in both pro-inflammatory and anti-inflammatory mediators, suggesting a complex role in the postoperative inflammatory response.
Pitfalls in Performing and Interpreting IPSS 2021.pdffrancisco551255
This document discusses pitfalls in performing and interpreting inferior petrosal sinus sampling (IPSS) based on a literature review and case examples. Key points include:
1) IPSS cannot confirm ACTH-dependent Cushing syndrome - biochemical testing is required first to establish the diagnosis.
2) Successful catheter placement relies on operator experience, and anatomical variations can complicate interpretation.
3) In ambiguous cases, adjunctive tests like prolactin measurement and prolactin-adjusted ACTH ratios may provide additional information.
4) A stepwise approach considering all clinical and biochemical data is needed for accurate IPSS interpretation.
Central venous pressure (CVP) is commonly used to guide fluid management, but its ability to predict fluid responsiveness is questionable. This systematic review analyzed 24 studies involving 803 patients. The review found a very poor relationship between CVP and blood volume. CVP was also unable to accurately predict a patient's fluid responsiveness, defined as an increase in stroke volume or cardiac index in response to fluid administration. The review demonstrated that CVP should not be used to make clinical decisions about fluid management.
Minimaly invasive hemodynamic monitoring for hepatic patients Dr.Mahmoud Abbas
Minimaly invasive Cardiovascular monitoring in hepatic patients in the icu lecture presented by Dr Khaled Yassen at the Egyptian African Critical care Summit
Integrated strategies for allogenic blood saving in major elective surgery ...anemo_site
This document discusses an integrated strategy implemented at a hospital in Rome, Italy since 2008 to reduce allogeneic blood transfusions for major elective surgeries. The strategy includes patient evaluation and supplementation if needed, along with autologous blood collection through pre-surgical donation or peri-surgical collection. Analysis of results from 2010 found that autologous unit usage increased 2.2 times, units not stored increased 2.4 times, and allogeneic unit transfusions were reduced by 65%, allowing for fresher blood transfusions to improve patient outcomes. The integrated strategy was more effective than previous practices at the hospital in conserving allogeneic blood supplies and reducing transfusion-related risks for patients.
Platelet function tests a review of progresses in456569Benedetto Morelli
This document summarizes platelet function tests and their clinical applications. It discusses that platelet function tests were traditionally used to diagnose bleeding disorders but are now also used to monitor antiplatelet drug efficacy and risk of thrombosis. It reviews currently available tests like aggregometry, flow cytometry, and thrombelastography. Aggregometry measures platelet aggregation in response to agonists and is still the gold standard, while other tests assess properties like granule release, activation markers, and clot kinetics. The tests can identify inherited or acquired platelet defects and monitor effects of medications on platelet activity.
This document summarizes a research article about developing a strategy for performing heart surgery on patients who refuse blood transfusions for religious reasons. The strategy involves four parts: administering high doses of erythropoietin preoperatively to increase red blood cell counts; optimizing platelet and coagulation levels; reinfusing lost blood intraoperatively and postoperatively; and restricting fluid administration to minimize dilution. This multimodal strategy has allowed over 200 heart surgeries to be performed at one hospital on patients refusing transfusions, with no transfusions required and mortality lower than expected.
Renal Replacement therapy (Dialytic Management) in AKI - Dr.GawadNephroTube - Dr.Gawad
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Transfusion requirements in living donor liver transplantation e Role of laboratory assessment and Model For End Stage Liver Disease (MELD) score
1. Transfusion requirements in living donor liver
transplantation e Role of laboratory assessment
and Model For End Stage Liver Disease (MELD) score
2. Original Article
Transfusion requirements in living donor liver
transplantation e Role of laboratory assessment
and Model For End Stage Liver Disease (MELD) score
R.N. Makroo a,
*, R. Walia b
, A. Bhatia c
, M. Chowdhry d
a
Director, Senior Consultant, Department of Transfusion Medicine, Indraprastha Apollo Hospitals, Sarita Vihar,
New Delhi, India
b
DNB Resident, Department of Transfusion Medicine, Indraprastha Apollo Hospitals, Sarita Vihar, New Delhi,
India
c
Sr. Registrar, Department of Transfusion Medicine, Indraprastha Apollo Hospitals, Sarita Vihar, New Delhi,
India
d
Associate Consultant, Department of Transfusion Medicine, Indraprastha Apollo Hospitals, Sarita Vihar,
New Delhi, India
a r t i c l e i n f o
Article history:
Received 17 April 2014
Accepted 3 May 2014
Available online xxx
Keywords:
MELD score
Liver transplant
Living donor
Prediction models
a b s t r a c t
Introduction and aims: Liver transplant surgery is often associated with considerable
bleeding. This study was undertaken to analyse the average blood component consump-
tion and the effectiveness of preoperative laboratory assessment and Model For End Stage
Liver Disease (MELD) score in the estimation of transfusion requirements in Living Donor
Liver Transplantation (LDLT).
Material and methods: Univariate and stepwise regression analysis were employed to
establish the significance of correlation of the preoperative laboratory variables, including
haematocrit, platelet count, INR, total bilirubin, serum creatinine, blood urea and MELD
score with the total consumption of Packed Red Cells (PRCs), cryoprecipitates, aphaeresis
platelets and Fresh Frozen Plasma (FFP). Stepwise discriminant analysis was used to
identify those preoperative factors which have a significant predictive value for the total
consumption of each blood component and these results were employed to construct
separate prediction models for the utilization of each blood component and the respective
R square values were determined.
Results: A total of 509 patients were included. On an average, 8.44 units (SD ¼ 6.11) of PRCs,
2.58 units (SD ¼ 2.95) of cryoprecipitates, 0.81 units (SD ¼ 1.16) of aphaeresis platelets and
2074.85 ml (SD ¼ 1240.20) of FFP were consumed per LDLT. The blood component prediction
models could be employed to accurately predict the total utilisation of PRCs, cry-
oprecipitates, FFP and aphaeresis platelets in 23, 22.6, 17.8 and 20.7 per cent of our patients,
respectively.
Conclusion: We have been able to identify those preoperative factors which can be
employed to predict the consumption of various blood components in living donor liver
graft recipients. These variables were further employed to construct prediction models,
* Corresponding author.
E-mail address: makroo@apollohospitals.com (R.N. Makroo).
Available online at www.sciencedirect.com
ScienceDirect
journal homepage: www.elsevier.com/locate/apme
a p o l l o m e d i c i n e x x x ( 2 0 1 4 ) 1 e6
Please cite this article in press as: Makroo RN, et al., Transfusion requirements in living donor liver transplantation e Role of
laboratory assessment and Model For End Stage Liver Disease (MELD) score, Apollo Medicine (2014), http://dx.doi.org/10.1016/
j.apme.2014.05.010
http://dx.doi.org/10.1016/j.apme.2014.05.010
0976-0016/Copyright ª 2014, Indraprastha Medical Corporation Ltd. All rights reserved.
3. separately for each blood component. We also identified those preoperative variables
which significantly influence the in hospital mortality and PLOS in LDLT recipients.
Copyright ª 2014, Indraprastha Medical Corporation Ltd. All rights reserved.
1. Introduction
Liver transplant surgery is often associated with considerable
bleeding, necessitating transfusion of blood and blood com-
ponents.1,2
Bleeding occurs largely because liver is an
extremely vascular organ3
and the associated bleeding is
compounded by the presence of portal hypertension4
and
abnormalities of the haemostatic system.5,6
This poses a
challenge to the blood transfusion services, particularly when
the supply of blood components is limited.7
Therefore, pre-
operative estimation of the blood component requirements in
patients undergoing liver transplantation would prove bene-
ficial for the blood transfusion services, by improving their
preparedness for such a major surgical procedure and helping
them in better resource allocation.
In order to address this issue, various factors have been
hypothesised as the potential predictors of blood component
usage in liver transplant surgeries. The proposed factors
include the recipient characteristics including recipient’s age,
gender, underlying diagnosis and the presence of any previ-
ous abdominal surgery; preoperative laboratory parameters
like haemoglobin, platelet count, international normalized
ratio (INR), renal parameters and the preoperative Model for
End Stage Liver Disease (MELD) score.8
However, there have
been conflicting reports as to whether such estimation can be
made preoperatively.9,10
In addition, only a limited number of
such reports are available for living donor liver trans-
plantations (LDLT).2
Therefore, the present study was undertaken to document
the average blood component consumption and to analyse the
effectiveness of preoperative laboratory assessment and
MELD score in the estimation of total i.e. intraoperative as well
as the postoperative transfusion requirements in LDLT.
2. Material and Methods
After the approval of the hospital ethical committee, this
study was conducted at the Department of Transfusion
Medicine and Department of Surgical Gastroenterology &
Liver Transplant, Indraprastha Apollo Hospitals, New Delhi,
from January 2009 to May 2012. The records of all the patients
who underwent LDLT at our centre, between January 2009 and
February 2010, were analysed retrospectively and since,
March 2010 all the liver graft recipients were prospectively
followed up during their stay in the hospital.
At our centre, whenever a liver transplant surgery is
planned, a blood component request form is sent to the blood
bank for the arrangement of 10 units of cross matched and
leukoreduced Packed Red Cells (PRCs), 4 units of cry-
oprecipitates, 10 units of fresh frozen plasma (FFP), 2 units of
single donor aphaeresis fresh frozen plasma and 2 units of
single donor aphaeresis platelets, which are kept ready one
day prior to the potential liver transplant surgery. A fresh
blood component request form is sent to the blood bank in
case a further need arises. The intraoperative blood compo-
nent transfusions were based on the clinical condition of the
patient and the results of Thromboelastography (Haemoscope
Corporation, USA). Unless contraindicated, each recipient
received Tranexamic acid in an initial bolus dose of 15 mg/kg
during the induction of anaesthesia and its subsequent use
was guided by the thromboelastography results.
Relevant data, including the patient’s age, gender, history
of dialysis in the week prior to surgery and preoperative
haematocrit, platelet count, INR, total serum bilirubin, serum
creatinine and blood urea, was obtained from the patient’s
case file. The formula, MELD ¼ 9.57 Â loge [creatinine mg/
dL] þ 3.78 Â loge [bilirubin mg/dL] þ 11.20 Â loge [INR] þ 0.643
was used to calculate the MELD score of each liver graft
recipient, based on the preoperative laboratory values of
serum bilirubin, serum creatinine, INR and history of dialysis
in the week prior to surgery.11
Data pertaining to the total number of blood components
consumed by each liver graft recipient during the intra-
operative and postoperative period was obtained from the
blood bank issue records. The number of units of plasma
(FFP and single donor plasma) was converted into plasma
volume in millilitres (ml). This calculation was based on the
results of our quality control measurements which show
that on an average, 1 unit of FFP is equivalent to 200 ml and
the volume of 1 unit of single donor aphaeresis plasma
prepared on a cell separator (Haemonetics, USA) is approx-
imately 600 ml.
Pearson’s correlation coefficients were employed in the
univariate statistical analysis to establish the significance of
correlation of the preoperative laboratory variables, including
haematocrit, platelet count, INR, total bilirubin, serum creat-
inine, blood urea and MELD score with the total consumption
of PRCs, cryoprecipitates, single donor aphaeresis platelets
and FFP. Further, stepwise regression analysis was performed
with all these variables to determine the best model that could
be employed to predict the utilization of each blood compo-
nent. A stepwise regression analysis and multivariate logistic
regression was employed to analyse the effect of various pa-
rameters on mortality during the hospital stay and post-
operative length of stay (PLOS) in the hospital. The various
parameters analysed were recipient’s age; preoperative labo-
ratory parameters including haematocrit, platelet count, INR,
total bilirubin, serum creatinine and blood urea; MELD score
and PRC use (intraoperative, postoperative and total). To
determine the effect of recipient’s gender on mortality and
PLOS in the hospital, Independent t-test and ManneWhitney
test were employed. SPSS version 15.0 was used for all sta-
tistical analyses and all the correlations were defined as sig-
nificant at p-value less than 0.05.
a p o l l o m e d i c i n e x x x ( 2 0 1 4 ) 1 e62
Please cite this article in press as: Makroo RN, et al., Transfusion requirements in living donor liver transplantation e Role of
laboratory assessment and Model For End Stage Liver Disease (MELD) score, Apollo Medicine (2014), http://dx.doi.org/10.1016/
j.apme.2014.05.010
4. 3. Results
A total of 534 patients underwent LDLT during the period of
study. Out of these, twenty-five cases were excluded, nineteen
of the recipients being under 16 years of age, three of the re-
cipients had a concomitant renal transplant and three had a
second liver transplant. None of the adult recipients included
in the study population received a cadaveric donor liver graft
and no intraoperative deaths were reported during the study
period. Out of the 509 patients remaining in the study popu-
lation, 416 (81.7%) were males and 93 (18.3%) were females.
The age of the patients included in the study ranged from 16 to
74 years, with a median of 50 years and mean age of 48.38
years (SD ¼ 10.27). The descriptive characteristics of various
parameters analysed are shown in Table 1.
On an average, a total of 8.44 units (SD ¼ 6.11) of PRCs were
consumed in a liver transplant (Fig. 1, Table 2). In the present
study, seventeen of the liver graft recipients, required no
intraoperative PRC transfusion while in eleven of them, no
PRC was transfused even in the postoperative period. Two of
the liver graft recipients did not require any transfusion dur-
ing the hospital stay. The average consumption of cry-
oprecipitates and aphaeresis platelets and per liver transplant
was 2.58 units (SD ¼ 2.95) and 0.81 units (SD ¼ 1.16),
respectively (Fig. 1, Table 2). The mean volume of FFP
consumed in a liver transplant was 2074.85 ml (SD ¼ 1240.20)
(Fig. 2, Table 2).
As shown in Table 3, univariate analysis demonstrated
that except for the preoperative serum creatinine (p value
>0.05), all the other variables correlated significantly (p < 0.05)
with the consumption of one or more blood components in a
liver transplant. Further evaluation with the stepwise
discriminant analysis, identified those preoperative factors
which have a significant predictive value for the total con-
sumption of each blood component in a liver graft recipient.
These results were further employed to construct separate
prediction models for the utilization of each blood component
and their respective R square values were determined. As
shown in Table 4, it was observed that the total PRC con-
sumption had a significant correlation with preoperative
haematocrit, blood urea and the MELD score. The total con-
sumption of cryoprecipitates was influenced by four factors
including the preoperative platelet count, haematocrit, MELD
score and INR. The total utilisation of FFP could be predicted
by employing preoperative MELD score, haematocrit and total
bilirubin while the preoperative platelet count and MELD score
influenced the total platelet transfusions (Table 4).
Multivariate logistic regression demonstrated that mor-
tality was significantly related to recipient’s age, preoperative
MELD score and total PRCs consumed. It was observed that
with a one year increase in age, the probability of mortality
increases by 4.3 per cent while with a one unit increase in
preoperative MELD score and that of total PRCs transfused,
there is an increase in the probability of mortality by 4.9 per
cent and 9.4 per cent respectively. We also calculated that the
total PRC consumption and preoperative blood urea had a
significant positive correlation with the PLOS in the hospital.
4. Discussion
In the present study, it was calculated that, on an average 8.44
units of PRCs were consumed per LDLT, with a median of 7
units. The average number of cryoprecipitates and single
donor aphaeresis platelets transfused was 2.58 units and 0.81
units, respectively while the average utilisation of FFP per liver
transplant was 2074.85 ml (Table 2). As shown in Table 4, the
total PRC consumption had a significant correlation with
preoperative haematocrit, blood urea and the MELD score
while the total consumption of cryoprecipitates was influ-
enced by the preoperative platelet count, haematocrit, MELD
score and the INR. It was also observed that the total uti-
lisation of FFP could be predicted by employing preoperative
Table 1 e Descriptive characteristics of various parameters.
Parameter Mean S.D. Median Minimum Maximum
Age (years) 48.38 10.27 50.00 16.00 74.00
Hct 0.27 0.06 0.27 0.13 0.44
Plt (Â109
/L) 74.78 51.47 62.00 7.00 469.00
INR 1.94 0.84 1.80 0.90 9.40
T. bilirubin (mmol/L) 115.25 156.81 54.72 3.42 957.26
B. urea (mg/dL) 38.29 32.10 27.00 8.00 209.00
S. crt (mmol/L) 76.27 66.40 46.98 5.00 433.16
MELD score 19.14 7.39 18.00 6.00 44.00
PLOS (days) 21.04 11.52 18.00 2.00 116.00
Abbreviations: Hct, Haematocrit; Plt, Platelet count; INR, International Normalised Ratio; T. bilirubin, Total bilirubin; B. urea, Blood urea; S. crt,
Serum creatinine; MELD, Model for End Stage Liver Disease; PLOS, Postoperative Length of Stay; SD, Standard Deviation.
Fig. 1 e Mean number (units) of blood components used in
liver transplant.
a p o l l o m e d i c i n e x x x ( 2 0 1 4 ) 1 e6 3
Please cite this article in press as: Makroo RN, et al., Transfusion requirements in living donor liver transplantation e Role of
laboratory assessment and Model For End Stage Liver Disease (MELD) score, Apollo Medicine (2014), http://dx.doi.org/10.1016/
j.apme.2014.05.010
5. MELD score, haematocrit and total bilirubin. Similarly, total
platelet transfusions were significantly correlated to preop-
erative platelet count, haematocrit and the MELD
score (Table 4).
Our study demonstrates that the preoperative haematocrit
had a negative influence on the consumption of PRCs, cry-
oprecipitates, FFPs and platelets i.e. a lower preoperative
haematocrit was associated with a higher consumption of
these blood components (Table 4). A negative association of
preoperative haematocrit with the PRC transfusion in liver
transplantation has also been reported previously by Massi-
cotte, et al.12
Moreover, the observed association of the pre-
operative haematocrit and the consumption of
cryoprecipitates, FFPs and platelets can be attributed to a
resultant decrease in haematocrit in the wake of active
bleeding that is associated with abnormalities of the coagu-
lation system and therefore, necessitates transfusion of these
blood components. A significant correlation was also
demonstrated between the preoperative INR and platelet
count with the total consumption of cryoprecipitates and
platelets, respectively (Table 4).
We also observed that the preoperative blood urea had a
positive association with the total utilization of PRCs which
can be attributed to uraemia, which is associated with
impaired renal function and may lead to disturbed coagula-
tion status and subsequent bleeding,13
requiring transfusion
with PRCs. Deakin et al, also concluded that elevated blood
urea was one of the predictors of bleeding in liver trans-
plants.7
The association of renal function impairment and
transfusion requirements in liver transplantation has also
been described in other studies.14e16
Moreover, renal
dysfunction that may be associated with End Stage Liver
Disease can aggravate anaemia as a result of reduced levels of
erythropoietin, leading to increased requirements of PRC
transfusion.17
Our findings show that the preoperative MELD score had a
positive correlation with the total consumption of all the
blood components including PRCs, cryoprecipitates, FFPs and
platelets and the observed associations were highly signifi-
cant. It was also reported by Peter E. Frasco, et al that MELD
score has a significant association with the blood component
therapy in liver transplantation.18
The observed association
of MELD score with the blood component utilization may be
due to the fact that the MELD score is calculated by using
serum bilirubin, serum creatinine and INR11
which represent
Table 2 e Blood component use in liver transplant.
Blood component Mean S.D. Median Minimum Maximum
Intraoperative PRC (units) 6.67 4.39 6.00 0.00 41.00
Cryo (units) 2.39 2.70 2.00 0.00 17.00
FFP (ml) 1735.17 845.25 1600.00 0.00 4400.00
Platelets (units) 0.57 0.73 0.00 0.00 4.00
Postoperative PRC (units) 1.77 3.45 0.00 0.00 31.00
Cryo (units) 0.19 1.13 0.00 0.00 16.00
FFP (ml) 349.02 815.11 0.00 0.00 8000.00
Platelets (units) 0.24 0.78 0.00 0.00 9.00
Total PRC (units) 8.44 6.11 7.00 0.00 41.00
Cryo (units) 2.58 2.95 2.00 0.00 17.00
FFP (ml) 2074.85 1240.20 2000.00 0.00 10,400.00
Platelets (units) 0.81 1.16 0.00 0.00 9.00
Fig. 2 e Mean volume (ml) of FFP used in liver transplant.
Table 3 e Univariate analysis of various parameters with blood component transfusion.
Total blood components Hct Plt (Â109
/L) INR T. bilirubin (mmol/L) B. urea (Mg/dl) S. crt (mmol/L) MELD
PRC (units) Correlation À0.37 À0.08 0.19 0.23 0.32 0.02 0.33
p-value 0.001 0.09 0.001 0.001 0.001 0.62 0.001
Cryo (units) Correlation À0.22 À0.21 0.34 0.27 0.13 À0.03 0.40
p-value 0.001 0.001 0.001 0.001 0.003 0.45 0.001
FFP (ml) Correlation À0.26 À0.09 0.31 0.22 0.19 À0.004 0.38
p-value 0.001 0.05 0.001 0.001 0.001 0.93 0.001
Platelets (units) Correlation À0.24 À0.36 0.17 0.13 0.15 0.014 0.25
p-value 0.001 0.001 0.001 0.004 0.001 0.76 0.001
Abbreviations: Hct, Haematocrit; Plt, Platelet count; INR, International Normalised Ratio; T. bilirubin, Total bilirubin; B. urea, Blood urea; S. crt,
Serum creatinine; MELD, Model for End Stage Liver Disease.
a p o l l o m e d i c i n e x x x ( 2 0 1 4 ) 1 e64
Please cite this article in press as: Makroo RN, et al., Transfusion requirements in living donor liver transplantation e Role of
laboratory assessment and Model For End Stage Liver Disease (MELD) score, Apollo Medicine (2014), http://dx.doi.org/10.1016/
j.apme.2014.05.010
6. a recipient’s hepatic, renal and haemostatic status,
respectively.
We observed that our blood component prediction models
could be employed to accurately predict the total utilisation of
PRCs, cryoprecipitates, FFP and aphaeresis platelets in 23, 22.6,
17.8 and 20.7 per cent of our patients, respectively (Table 4). This
shows that besides the preoperative laboratory parameters and
MELD score, other variables might also influence the blood
component consumption in liver transplants. These variables
could possibly include the intraoperative, technical and general
patient factors, which were not considered in the present study.
It was also seen that the in hospital mortality was signifi-
cantly related to recipient’s age, preoperative MELD score and
total PRCs consumed. A one year increase in the recipient’s
age, increased the probability of mortality by 4.3 per cent.
Similarly, with one unit increase in preoperative MELD score
and that of total PRCs transfused, there was an increase in the
probability of mortality by 4.9 per cent and 9.4 per cent
respectively. PLOS in the hospital was also calculated to be
positively influenced by the total PRC consumption and pre-
operative blood urea.
To the best of our knowledge, the present study is one of
the largest single centre studies that have been undertaken to
identify the significance of preoperative laboratory assess-
ment in estimating the transfusion needs in LDLT. We have
tried to present an extensive analysis of the total i.e. intra-
operative and postoperative, consumption of various blood
components in liver transplantation and have also con-
structed separate prediction models to estimate the use of
each blood component.
However, there still are some limitations in our study. The
present study is limited to the preoperative laboratory vari-
ables and the MELD score only and does not include the effect
of intraoperative, technical and general patient factors on
blood component consumption. It is possible that the inclu-
sion of all these factors might even have resulted in the con-
struction of improved prediction models with higher R square
values and better predictive power. However, the main focus
of our study was to analyse the effect of preoperative labora-
tory parameters and MELD score only, in order to draw defi-
nite conclusions with regard to their predictability by
analysing their role in such a large number of patients.
Moreover, our findings may not be applicable to centres
following a different protocol for liver transplantation and to
centres performing cadaveric donor liver transplants.
To conclude, we have calculated our blood component
consumption in 509 LDLTs. Moreover, we have been able to
identify those preoperative factors which can be employed to
predict the consumption of various blood components in
living donor liver graft recipients. These variables were
further employed to construct prediction models, separately
for each blood component. We also identified those preoper-
ative variables which significantly influence the in hospital
mortality and PLOS in LDLT recipients.
Conflicts of interest
All authors have none to declare.
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Table 4 e Blood component prediction models.
Predicted blood
component
Predicting factors R2
(%) Prediction model P-value
Total PRC (units) Hct
B. urea (mg/dL)
MELD score
23.0 12.454e30.7 Â Hct þ 0.036 Â B. urea þ 0.156 Â MELD 0.001
Cryo (units) MELD score
Plt (Â109
/L)
Hct
INR
22.6 1.775 þ 0.113 Â MELDÀ0.012 Â PltÀ4.9 Â Hct þ 0.461 INR 0.001
FFP (ml) MELD score
Hct
T. bilirubin (mmol/L)
17.8 1748.996 þ 75.310 Â MELDÀ3589.3 Â HctÀ19.870 Â (T. bilirubin/17.1) 0.001
Platelets
(units)
Plt (Â109
/L)
MELD score
Hct
20.7 1.317e7.7 Â 10À3
Plt þ 0.037 Â MELDÀ2.3 Â Hct 0.001
Abbreviations: Hct, Haematocrit; Plt, Platelet count; INR, International Normalised Ratio; T. bilirubin, Total bilirubin; B. urea, Blood urea; MELD,
Model for End Stage Liver Disease.
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laboratory assessment and Model For End Stage Liver Disease (MELD) score, Apollo Medicine (2014), http://dx.doi.org/10.1016/
j.apme.2014.05.010
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a p o l l o m e d i c i n e x x x ( 2 0 1 4 ) 1 e66
Please cite this article in press as: Makroo RN, et al., Transfusion requirements in living donor liver transplantation e Role of
laboratory assessment and Model For End Stage Liver Disease (MELD) score, Apollo Medicine (2014), http://dx.doi.org/10.1016/
j.apme.2014.05.010