A Single-Centre Review of Transfusion Practices and Blood Wastage in Liver Transplantation

Abstract

Background: Liver transplantation is associated with massive blood loss due to a combination of coagulopathy, portal hypertension, and multiple vascular transection and anastomoses. Multiple blood transfusions over a short time frame may result in significant blood and component wastage due to over-ordering of blood products and component time expiry. Blood wastage in the setting of liver transplantation is yet to be reviewed. We reviewed transfusion practices during liver transplantation and audited blood component and product wastage. Methods: We performed a single-center retrospective review of all adult patients aged >16 years over a period of a year. A total of 181 cases were included in the review. Results: Eighty-seven percent of liver transplants were first transplants and were mainly due to chronic liver failure. Our cohort had a median blood loss of 4249 mL (IQR 2830, 6576) per transplant. Patients having redo procedures or have acute liver failure as a presenting aetiology bled significantly more. Nearly all our patients received blood products during the perioperative period. Fresh frozen plasma (FFP) was transfused in 91.2% of our cohort, followed by packed red cells (PRC, 64.2%), platelets (52.5%) and cryoprecipitates (32.0%). A total of 142 units of blood and blood product were wasted. This equates to a wastage rate of 4.6%. This is higher than the target of 3% set by our institution. Highest wastage rates were seen in FFP (8.6%), followed by PRC (2.2%), cryoprecipitates (1.0%) and platelets (0.9%). The commonest cause of wastage was “time expired”. The total cost of wastage is £9800, which represents 3.3% of the total cost of blood products transfused. Conclusion: Changing blood component ordering habits, staff training, and awareness may help reduce wastage of this precious commodity.