The Impact Of Perioperative Single-donor Platelet(Apheresis) On Survival In Adult-to-adult Living Donor Liver Transplantation

Background:Although many previous studies have confirmed that perioperative blood transfusion is associated with poor outcomes after liver transplantation,few studies described the influence of single-donor platelet(apheresis)transfusion in living donor liver transplantation(LDLT).This study aimed to assess the effect of blood products on outcomes for LDLT recipients,focusing on apheresis platelets.Methods:This retrospective study included 126 recipients who underwent their first adult-to-adult LDLT.Twenty-four variables including blood products consumption of 126 LDLT recipients were assessed for their link to short-term outcomes and overall survival.Kaplan-Meier survival curve and the log-rank test were used for recipient survival analysis.A multivariate Cox proportional-hazard model and a propensity score analysis were applied to adjust confounders after potential risk factors were identified by a univariate Cox analysis.Results:Patients who received apheresis platelet transfusion had a lower 90-day cumulative survival(78.9%vs.94.2%,P=0.009)but had no significant difference in overall survival in the Cox model,compared with those without apheresis platelet transfusion.Units of apheresis platelet transfusion(hazard ratio[HR]=3.103,95%confidence interval[CI]:1.720-5.600,P<0.001)and pre-operative platelet count(HR=0.170,95%CI:0.040-0.730,P=0.017)impacted 90-day survival independently.Multivariate Cox regression analysis also found that units of red blood cell(RBC)transfusion(HR=1.036,95%CI:1.006-1,067,P=0.018),recipient’s age(HR=1.045,95%CI:1.005-1.086,P=0.025)and ABO-blood group comparison(HR=2.990,95%Cl:1.341-6.669,P=0.007)were independent risk factors for overall survival after LDLT.Conclusion:This retrospective study suggested that apheresis platelets were only associated with early mortality,but had no impact on overall survival in LDLT.Units of RBC,recipient’s age and ABO-group comparison were independent predictors of long-term outcomes.