Associação entre o uso de hemocomponentes no perioperatório de transplante hepático e sobrevida em cinco anos

Abstract

Background: Liver transplantation has been associated with major blood loss and need for allogenic blood product transfusions. Intraoperative red blood cell transfusion may contribute to morbidity and mortality. In this study we evaluated the impact of various blood products during whole hospitalization on fiver years after liver transplantation and the association between intraoperative variables with five years survival. Methods: Several variables, including blood product transfusions, preoperative renal function, thromboelastography, Intensive Care Unit stay and hospitalization discharge were studied in relation to outcome in 93 adult patients undergoing a liver transplantation between 2001 and 2004 at Hospital das Clínicas of Federal University of Minas Gerais.!!Patient survival was calculated according to the Kaplan-Meier method. Categorical variables were compared using Fishers exact test. All variables tested in the univariate analysis with a P<0,2 were included in a multivariate survival analysis. Results: The mean number of accumulative red blood cells transfused was 8,87+9,5, plasma 3,77+8,17, platelets 10,11+15,2 and cryoprecipate 3,69+8,43. One year and five year survival was 81,7% and 76,3% respectively. Oppositely to intraoperative period, accumulative transfusion of red blood cells, plasma and platelets during hospitalization were associated with lower five years survival after liver transplantation. The normal or hipercoagulability thromboelastography, preoperative renal dysfunction, longer Intensive Care Unit and hospitalization stay were associated to lower Five years survival. Conclusion: Although we cannot demonstrate causality, our analysis shows that five year survival rate following liver transplantation decreased significantly with transfusion of red blood cells, plasma or platelets during hospitalization.