Factors Associated With Intraoperative Blood Loss in Living Donor Liver Transplantation.

BACKGROUND Although several studies have assessed factors associated with intraoperative blood loss (IBL) during liver transplantation, most have been conducted on brain-dead donors, with few studies on living donors that have reported inconsistent findings. This study retrospectively investigated factors associated with IBL in living-donor liver transplantation (LDLT).

METHODS This study included 250 patients aged ≥20 years who underwent LDLT at our institution between January 2013 and September 2018. IBL, obtained from anesthetic records, was subjected to log-transformation and analyzed using a general linear regression model. The backward method was used for variable selection and the values were exponentially transformed to describe the results.

RESULTS Multivariable analysis revealed that male sex (vs female, 1.37-fold, 95% confidence interval (CI): 1.14-1.66), body mass index (BMI) (1.05-fold for every 1 kg/m2 increase, 95% CI: 1.03-1.08), platelet count (0.98-fold for every 10,000/µL increase, 95% CI: 0.96-0.99), white blood cell (WBC) count (1.04-fold for every 1000/µL increase, 95% CI: 1.002-1.08), serum sodium ion (Na+) levels (0.96-fold for every 1 mEq/L increase, 95% CI: 0.94-0.98), serum total protein (TP) (0.88-fold for every 1 g/dL increase, 95% CI: 0.79-0.98), and use of a venous bypass (vs nonuse, 1.96-fold, 95% CI: 1.01-3.73) were significantly associated with IBL.

CONCLUSIONS Male sex, high BMI, low platelet count, high WBC count, low Na+ levels, low TP levels, and the use of venous bypass can lead to excessive IBL during LDLT. Preoperative assessment of these factors is crucial for perioperative management.