Effect of cell salvage on bleeding, transfusion of blood products, and bleeding parameters in patients undergoing liver transplantation with intraoperative massive blood transfusion.

BACKGROUND

Autologous transfusion using a cell saver system has been used in liver transplantation with controversial outcomes. Its efficiency in patients with massive intraoperative transfusion has not been studied yet. This study aimed to evaluate effect of cell salvage (CS) on intraoperative bleeding and transfusion practices in liver transplantation with massive intraoperative transfusion.

METHODS

Consecutive patients aged ≥18 years with intraoperative massive blood transfusion (≥ 6 units) between March 2014 and September 2020 were included. Patients subjected to CS were grouped as CS, whereas other patients were grouped as control. Number of transfused red blood cells was study's primary outcome.

RESULTS

There were 38 and 32 patients in CS and control groups, respectively. Median blood loss was significantly lower in CS group than in control group (2500 mL vs. 4000 mL, p = 0.010). There were significantly more transfusions of red blood cells, fresh frozen plasma, platelets, and cryoprecipitates in CS group (p < 0.05). Postoperative median hemoglobin levels were determined as 4.8 g/dL and 8.2 g/dL in CS and control groups (p < 0.001). The decrease in postoperative hemoglobin levels compared to preoperative values was significantly higher in the CS group (p < 0.001). The mortality rate in postoperative first year was significantly higher in CS group than in control group (36.8% vs. 12.5%, p = 0.041).

DISCUSSION

Use of CS in patients undergoing liver transplantation with massive intraoperative transfusion did not improve clinical and transfusion-related outcomes. In conclusion, its usage can be questionable given the absence of any clinical benefit and presence of poor outcomes.