Massive blood transfusion after the first cut in liver transplantation predicts renal outcome and survival
Reichert B, Kaltenborn A, Becker T, Schiffer M, Klempnauer J, Schrem H (2014)
Publication Type: Journal article
Publication year: 2014
Journal
Book Volume: 399
Pages Range: 429-440
Journal Issue: 4
DOI: 10.1007/s00423-014-1181-y
Abstract
Introduction: Transfusion requirements of blood products may provide useful prognostic factors for the prediction of short-term patient mortality and renal outcome after liver transplantation. Patients and methods: Two hundred ninety-one consecutive liver transplants in adults were analysed retrospectively. Combined and living-related liver transplants were excluded. The amount of transfused packed red blood cells (PRBC) and units of platelets (UP) within the first 48 h were investigated as prognostic factors to predict short-term patient mortality and renal outcome. Receiver operating characteristic (ROC) curve analysis with area under the curve (AUC), Hosmer-Lemeshow tests and Brier scores were used to calculate overall model correctness, model calibration and accuracy of prognostic factors. Cut-off values were determined with the best Youden index. Results: The potential clinical usefulness of PRBC as a prognostic factor to predict 30-day mortality (cut-off 17.5 units) and post-transplant haemodialysis (cut-off 12.5 units) could be demonstrated with AUCs >0.7 (0.712 and 0.794, respectively). Hosmer-Lemeshow test results and Brier scores indicated good overall model correctness, model calibration and accuracy. The UP proved as an equally clinically useful prognostic factor to predict end-stage renal disease (cut-off 3.5 units; AUC=0.763). The association of cut-off levels of PRBC with patient survival (p<0.001, log-rank test) and dialysis-free survival (p<0.001, log-rank test) was significant (cut-off levels 17.5 and 12.5 units, respectively) as well as the association of UP with dialysis-free survival (p<0.001, log-rank test) (cut-off level 3.5 units). Conclusions: The impressive discriminative power of these simple prognostic factors for the prediction of outcome after liver transplantation emphasizes the relevance of strategies to avoid excessive transfusion requirements. © 2014 Springer-Verlag.
Authors with CRIS profile
Involved external institutions
Medizinische Hochschule Hannover (MHH) / Hannover Medical School
Germany (DE)
Universitätsklinikum Schleswig-Holstein (UKSH)
Germany (DE)
Germany (DE)
Universitätsklinikum Schleswig-Holstein (UKSH)
Germany (DE)
How to cite
APA:
Reichert, B., Kaltenborn, A., Becker, T., Schiffer, M., Klempnauer, J., & Schrem, H. (2014). Massive blood transfusion after the first cut in liver transplantation predicts renal outcome and survival. Langenbecks Archives of Surgery, 399(4), 429-440. https://doi.org/10.1007/s00423-014-1181-y
MLA:
Reichert, Benedikt, et al. "Massive blood transfusion after the first cut in liver transplantation predicts renal outcome and survival." Langenbecks Archives of Surgery 399.4 (2014): 429-440.
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