{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T01:21:03Z","timestamp":1787016063849,"version":"build-2736575974"},"reference-count":21,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2023,7,26]],"date-time":"2023-07-26T00:00:00Z","timestamp":1690329600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Transfusion"],"published-print":{"date-parts":[[2023,9]]},"abstract":"Abstract<\/jats:title>\n \n Background<\/jats:title>\n Massive hemorrhage and transfusion during liver transplantation (LT) present great challenges. We aimed to investigate the incidence and risk factors for super\u2010massive transfusion (SMT) and survival outcome and factors that negatively affect survival in patients who received SMT during LT.<\/jats:p>\n <\/jats:sec>\n \n Study Design and Methods<\/jats:title>\n We included adult patients undergoing LT from 2004 to 2019. SMT was defined as transfusion of \u226550\u2009units of red blood cells (RBC) during LT. Independent risk factors were identified by multivariable logistic regression. Ninety\u2010day survival was recorded and factors that negatively affected survival were analyzed by the Cox survival test.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n Of 2772 patients, 158 (5.6%) received SMT during LT. Mean RBC transfusion was 72.6 (\u00b123.4) units with a maximum of 168\u2009units. Four variables (MELD\u2010Na score, previous upper abdominal surgery, portal vein thrombosis, and remote retransplant) were independent risk factors for SMT (odds ratio 1.800\u20138.274, 95% CI 1.008\u201316.685, all\n p<\/jats:italic>\n \u2009<\u2009.005). The 90\u2010day survival rate in SMT patients was 81.6%. Preoperative pulmonary hypertension and massive postreperfusion transfusion negatively affected 90\u2010day survival (hazard ratio 2.658\u20134.633, 95% CI 1.144\u201310.130, and all\n p<\/jats:italic>\n \u2009<\u2009.05).\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n In this large retrospective study, we found that SMT occurred in a small percentage of patients and was associated with relatively satisfactory short\u2010term survival. Identification of preoperative risk factors for SMT and factors that negatively affect survival improve our understanding of this unique LT patient population.<\/jats:p>\n <\/jats:sec>","DOI":"10.1111\/trf.17496","type":"journal-article","created":{"date-parts":[[2023,7,26]],"date-time":"2023-07-26T09:19:36Z","timestamp":1690363176000},"page":"1677-1684","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":11,"title":["Super\u2010massive transfusion during liver transplantation"],"prefix":"10.1111","volume":"63","author":[{"given":"Warangkana","family":"Lapisatepun","sequence":"first","affiliation":[{"name":"Departments of Anesthesiology, Ronald Reagan UCLA Medical Center David Geffen School of Medicine at UCLA Los Angeles California USA"},{"name":"Department of Anesthesiology, Faculty of Medicine Chiang Mai University Chiang Mai Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christina","family":"Ma","sequence":"additional","affiliation":[{"name":"Departments of Anesthesiology, Ronald Reagan UCLA Medical Center David Geffen School of Medicine at UCLA Los Angeles California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Worakitti","family":"Lapisatepun","sequence":"additional","affiliation":[{"name":"Department of Surgery, Faculty of Medicine Chiang Mai University Chiang Mai Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vatche","family":"Agopian","sequence":"additional","affiliation":[{"name":"Departments of Surgery, Ronald Reagan UCLA Medical Center David Geffen School of Medicine at UCLA Los Angeles California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher","family":"Wray","sequence":"additional","affiliation":[{"name":"Departments of Anesthesiology, Ronald Reagan UCLA Medical Center David Geffen School of Medicine at UCLA Los Angeles California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1182-3179","authenticated-orcid":false,"given":"Victor W.","family":"Xia","sequence":"additional","affiliation":[{"name":"Departments of Anesthesiology, Ronald Reagan UCLA Medical Center David Geffen School of Medicine at UCLA Los Angeles California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2023,7,26]]},"reference":[{"key":"e_1_2_6_2_1","doi-asserted-by":"publisher","DOI":"10.1213\/ANE.0000000000001994"},{"key":"e_1_2_6_3_1","first-page":"659","article-title":"Homotransplantation of the liver in humans","volume":"117","author":"Starzl TE","year":"1963","journal-title":"Surg Gynecol 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