The Impact Of Different Transfusion Strategies On Outcomes After Pediatric Liver Transplantation

OBJECTIVE: This study was designed to explore the effect of restrictive transfusion strategies on the prognosis after Pediatric Liver Transplantation,to provide reference to perioperative transfusion of Pediatric Liver Transplantation,and to provide evidence for transfusion of Pediatric Liver Transplantation.METHODS: This study was divided into two parts: retrospective study and prospective study.Retrospective study: Patients were grouped into 2 categories based on the levels of postoperative hemoglobin: Group H consisted of patients that the postoperative Hemoglobin(Hb)level > 8 g/d L(n=301),Group L consisted of patients that the postoperative Hb level between 6 g/d L to 8g/d L(n=137).The primary outcome was 1-year survival rates.Secondary outcomes included: perioperative blood transfusion,postoperative complications,Intensive Care Unit(ICU)Mechanical ventilation(MV)duration and Lengths of stay in the ICU and in hospital.Prospective study: The hemoglobin concentrations of patients assigned to the restrictive transfusion strategy were maintained in the range of 6-8 g/d L,with a transfusion given when the hemoglobin concentration fell below 6 g/d L.Patients assigned to the liberal transfusion strategy,the hemoglobin concentrations were maintained in the range of 8-10 g/d L,with a threshold for transfusion of 8 g/d L.The primary outcome was 6-month survival rates.Secondary outcomes included: Perioperative blood transfusion,postoperative complications,ICU MV duration,Lengths of stay in the ICU and in hospital.RESULTS: The retrospective study:(1)Compared with group H,the 1-year survival rates of group L was significantly higher than that of group H.(2)There were no statistical differences in the secondary outcomes: The Clavien–Dindo Classification of Surgical Complications,ICU MV duration,Lengths of stay in the ICU and in hospital.Prospective study:(1)Neither survival rates,Lengths of stay in the ICU and in hospital,nor the oxygen metabolism and circulation stability of tissues during Pediatric Liver Transplantation were effected by restrictive transfusion strategy;(2)Restrictive transfusion strategy could significantly reduce intraoperative blood loss and transfusion.This study confirmed that restrictive transfusion strategy(Transfusion threshold: 6 g/d L,Target Hb: 6-8 g/d L)used in Pediatric Liver Transplantation could effectively reduce the use of Packed Red Blood Cells(PRBC),without effecting the 6-month survival rates and postoperative complications.CONCLUSIONS: This study demonstrates that the restrictive transfusion strategy(Transfusion threshold: 6 g/d L,Target Hb: 6-8 g/d L)could be safely used in Pediatric Liver Transplantation without effecting the post-operative mortality,the tissue oxygen metabolism and circulatory stability,ICU MV duration,the ICU length of stay and postoperative length of stay.