{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T01:29:14Z","timestamp":1760146154734,"version":"build-2065373602"},"reference-count":33,"publisher":"MDPI AG","issue":"19","license":[{"start":{"date-parts":[[2024,9,27]],"date-time":"2024-09-27T00:00:00Z","timestamp":1727395200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: Intraoperative blood transfusion (IOBT) during liver transplantation (LT) has negative outcomes, and it has been shown that an increasing number of these procedures may no longer require IOBT. Regarding living donor liver transplantation (LDLT), the literature on the pre-transplant predictors of IOBT is quite heterogeneous and deficient. In this study, we reviewed our experience of IOBT among a homogenous cohort of adult right-lobe LDLTs. Methods: We conducted a retrospective analysis of prospectively collected data on adult LDLT recipients between January 2018 and October 2023. Two groups were constructed (No-IOBT vs. IOBT) for the exploration of pre- and intraoperative predictors of IOBT using univariate and multivariate analyses. An ROC curve analysis was applied to identify possible cut-offs. The one-year post-LDLT overall survival was compared using the Kaplan\u2013Meier method. A p-value &lt; 0.05 was considered statistically significant. Results: A total of 219 adult LDLT recipients were enrolled. The No-IOBT (n = 56) patients were mostly males (p = 0.016), with higher preoperative levels of HGB (p &lt; 0.001), fibrinogen (p = 0.005), and albumin (p = 0.007) and a lower incidence of pre-transplant upper abdominal surgery (p = 0.017), portal vein thrombosis (p = 0.04), hepatorenal syndrome (p = 0.015), and ascites (p = 0.02) than the IOBT group (n = 163). The No-IOBT group had a shorter anhepatic phase (p = 0.002) and received fewer intravenous crystalloids (p = 0.001). In the multivariate analysis, the pre-transplant HGB (p &lt; 0.001), fibrinogen (p &lt; 0.001), and albumin (p = 0.04) levels were independent predictors of IOBT, showing the following cut-offs in the ROC curve analysis: HGB \u2264 11.5 (AUC: 0.800, p &lt; 0.001), fibrinogen \u2264 125 (AUC: 0.638, p = 0.0024), and albumin \u2264 3.6 (AUC: 0.663, p = 0.0002). These were significantly associated with the No-IOBT group. The one-year overall survival of the No-IOBT and IOBT groups was 100% and 83%, respectively (p = 0.007). Conclusions: IOBT during LDLT is associated with inferior outcomes. The increased need of IOBT during LT can be predicted by evaluating serum levels of hemoglobin, albumin and fibrinogen before liver transplantation.<\/jats:p>","DOI":"10.3390\/jcm13195776","type":"journal-article","created":{"date-parts":[[2024,9,27]],"date-time":"2024-09-27T09:16:10Z","timestamp":1727428570000},"page":"5776","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Factors Affecting Intraoperative Blood Transfusion Requirements during Living Donor Liver Transplantation"],"prefix":"10.3390","volume":"13","author":[{"given":"Hakan","family":"Kilercik","sequence":"first","affiliation":[{"name":"Department of Anesthesiology and Reanimation, Gaziosmanpasa Hospital, Faculty of Medicine, Istanbul Yeni Yuzyil University, 34010 Istanbul, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6864-7711","authenticated-orcid":false,"given":"Sami","family":"Akbulut","sequence":"additional","affiliation":[{"name":"Department of Surgery, Liver Transplant Institute, Faculty of Medicine, Inonu University, 44280 Istanbul, Turkey"},{"name":"Department of Surgery and Organ Transplantation, Gaziosmanpasa Hospital, Faculty of Medicine, Istanbul Yeni Yuzyil University, 34010 Istanbul, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0299-5473","authenticated-orcid":false,"given":"Ahmed","family":"Elsarawy","sequence":"additional","affiliation":[{"name":"Department of Surgery and Organ Transplantation, Gaziosmanpasa Hospital, Faculty of Medicine, Istanbul Yeni Yuzyil University, 34010 Istanbul, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sema","family":"Aktas","sequence":"additional","affiliation":[{"name":"Department of Surgery and Organ Transplantation, Gaziosmanpasa Hospital, Faculty of Medicine, Istanbul Yeni Yuzyil University, 34010 Istanbul, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Utku","family":"Alkara","sequence":"additional","affiliation":[{"name":"Department of Radiology, Gaziosmanpasa Hospital, Faculty of Medicine, Istanbul Yeni Yuzyil University, 34010 Istanbul, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8728-5472","authenticated-orcid":false,"given":"Sinasi","family":"Sevmis","sequence":"additional","affiliation":[{"name":"Department of Surgery and Organ Transplantation, Gaziosmanpasa Hospital, Faculty of Medicine, Istanbul Yeni Yuzyil University, 34010 Istanbul, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2024,9,27]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"161","DOI":"10.1016\/j.trre.2014.12.002","article-title":"Liver transplantation in Turkey: Historical review and future perspectives","volume":"29","author":"Akbulut","year":"2015","journal-title":"Transplant. Rev."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"278","DOI":"10.6002\/ect.2012.0060","article-title":"Living-donor liver transplant using the right hepatic lobe without the right hepatic vein: Solving the drainage problem","volume":"11","author":"Akbulut","year":"2013","journal-title":"Exp. Clin. Transplant."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"299","DOI":"10.1007\/s12072-023-10629-3","article-title":"Asian Pacific Association for the Study of the Liver clinical practice guidelines on liver transplantation","volume":"18","author":"Kim","year":"2024","journal-title":"Hepatol. Int."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"311","DOI":"10.1016\/j.hbpd.2020.06.016","article-title":"Techniques for overcoming atretic changes of the portal vein in living donor liver transplantation","volume":"19","author":"Lee","year":"2020","journal-title":"Hepatobiliary Pancreat. Dis. Int."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"6146","DOI":"10.3748\/wjg.v20.i20.6146","article-title":"Transfusion and coagulation management in liver transplantation","volume":"20","author":"Clevenger","year":"2014","journal-title":"World J. Gastroenterol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"2477","DOI":"10.1016\/j.transproceed.2020.03.052","article-title":"Impact of Blood Loss and Intraoperative Blood Transfusion During Liver Transplantation on the Incidence of Early Biliary Complications and Mortality","volume":"52","author":"Jozwik","year":"2020","journal-title":"Transplant. Proc."},{"key":"ref_7","first-page":"64","article-title":"High intraoperative blood product requirements in liver transplantation: Risk factors and impact on the outcome","volume":"26","author":"Teofili","year":"2022","journal-title":"Eur. Rev. Med. Pharmacol. Sci."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"2057","DOI":"10.1111\/trf.17074","article-title":"Blood products and liver transplantation: A strategy to balance optimal preparation with effective blood stewardship","volume":"62","author":"Little","year":"2022","journal-title":"Transfusion"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1276","DOI":"10.1097\/TP.0b013e318250fc25","article-title":"Transfusion rate for 500 consecutive liver transplantations: Experience of one liver transplantation center","volume":"93","author":"Massicotte","year":"2012","journal-title":"Transplantation"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"370","DOI":"10.1016\/j.hpb.2021.06.425","article-title":"The effect of perioperative packed red blood cells transfusion on patient outcomes after liver transplant for hepatocellular carcinoma","volume":"24","author":"Muaddi","year":"2022","journal-title":"HPB"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1584","DOI":"10.1002\/lt.20868","article-title":"Derivation of a risk index for the prediction of massive blood transfusion in liver transplantation","volume":"12","author":"McCluskey","year":"2006","journal-title":"Liver Transpl."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"350","DOI":"10.1097\/01.sla.0000133352.25163.fd","article-title":"Live donor liver transplantation without blood products: Strategies developed for Jehovah\u2019s Witnesses offer broad application","volume":"240","author":"Jabbour","year":"2004","journal-title":"Ann. Surg."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"10732748211011960","DOI":"10.1177\/10732748211011960","article-title":"Living Donor Liver Transplantation: The Optimal Curative Treatment for Hepatocellular Carcinoma Even Beyond Milan Criteria","volume":"28","author":"Alim","year":"2021","journal-title":"Cancer Control"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"467","DOI":"10.1002\/jhbp.235","article-title":"Portal vein reconstruction in adult living donor liver transplantation for patients with portal vein thrombosis in single center experience","volume":"22","author":"Mori","year":"2015","journal-title":"J. Hepatobiliary Pancreat. Sci."},{"key":"ref_15","first-page":"107","article-title":"A review of current status of living donor liver transplantation","volume":"5","author":"Park","year":"2016","journal-title":"Hepatobiliary Surg. Nutr."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"2055","DOI":"10.1007\/s11605-018-3876-9","article-title":"Outcomes of Living Donor Liver Transplantation for Patients with Preoperative Portal Vein Problems","volume":"22","author":"Wahab","year":"2018","journal-title":"J. Gastrointest. Surg."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"187","DOI":"10.1016\/j.ijsu.2018.04.041","article-title":"The surgical challenges of salvage living donor liver transplantation for Hepatocellular carcinoma; The cumulative experience of 100 cases\u2014A retrospective cohort study and a propensity score analysis","volume":"54","author":"Yong","year":"2018","journal-title":"Int. J. Surg."},{"key":"ref_18","first-page":"798","article-title":"Novel Benchmark for Adult-to-Adult Living-donor Liver Transplantation: Integrating Eastern and Western Experiences","volume":"278","author":"Li","year":"2023","journal-title":"Ann. Surg."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"e13191","DOI":"10.1111\/ctr.13191","article-title":"Balanced blood product transfusion during liver transplantation","volume":"32","author":"Hogen","year":"2018","journal-title":"Clin. Transplant."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"e13581","DOI":"10.1097\/MD.0000000000013581","article-title":"Bloodless living donor liver transplantation: Risk factors, outcomes, and diagnostic predictors","volume":"97","author":"Yoon","year":"2018","journal-title":"Medicine"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1500","DOI":"10.1016\/j.ijsu.2014.07.014","article-title":"Strengthening the Reporting of Observational Studies in Epidemiology (STROBE): Explanation and elaboration","volume":"12","author":"Vandenbroucke","year":"2014","journal-title":"Int. J. Surg."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"395","DOI":"10.1093\/ajcp\/aqy154","article-title":"Quality Improvement in Transfusion Practice of Orthotopic Liver Transplantation Reduces Blood Utilization, Length of Hospital Stay, and Cost","volume":"151","author":"Nedelcu","year":"2019","journal-title":"Am. J. Clin. Pathol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1","DOI":"10.4254\/wjh.v5.i1.1","article-title":"Blood loss, predictors of bleeding, transfusion practice and strategies of blood cell salvaging during liver transplantation","volume":"5","author":"Feltracco","year":"2013","journal-title":"World J. Hepatol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"119","DOI":"10.4103\/ija.IJA_401_18","article-title":"Predicting packed red blood cell transfusion in living donor liver transplantation: A retrospective analysis","volume":"63","author":"Singh","year":"2019","journal-title":"Indian J. Anaesth."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1689","DOI":"10.1097\/TP.0b013e3181a5e5f1","article-title":"MELD score and blood product requirements during liver transplantation: No link","volume":"87","author":"Massicotte","year":"2009","journal-title":"Transplantation"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"3207","DOI":"10.1016\/j.transproceed.2007.09.029","article-title":"Predictors of blood product use in orthotopic liver transplantation using the piggyback hepatectomy technique","volume":"39","author":"Mangus","year":"2007","journal-title":"Transplant. Proc."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"1320","DOI":"10.1016\/jlts.2003.50204","article-title":"Intraoperative red blood cell transfusion in liver transplantation: Influence on patient outcome, prediction of requirements, and measures to reduce them","volume":"9","author":"Ramos","year":"2003","journal-title":"Liver Transpl."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"165","DOI":"10.5500\/wjt.v5.i4.165","article-title":"Reducing transfusion requirements in liver transplantation","volume":"5","author":"Donohue","year":"2015","journal-title":"World J. Transplant."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"100797","DOI":"10.1016\/j.trre.2023.100797","article-title":"Preoperative fibrinogen level and blood transfusions in liver transplantation: A systematic review","volume":"37","author":"Thibeault","year":"2023","journal-title":"Transplant. Rev."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"507","DOI":"10.6002\/ect.2016.0325","article-title":"The Impact of Preoperative Variables on Intraoperative Blood Loss and Transfusion Requirements During Orthotopic Liver Transplant","volume":"17","author":"Eghbal","year":"2019","journal-title":"Exp. Clin. Transplant."},{"key":"ref_31","first-page":"53","article-title":"Pre-operative predictors of red blood cell transfusion in liver transplantation","volume":"15","year":"2017","journal-title":"Blood Transfus."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"1398","DOI":"10.1016\/j.transproceed.2006.02.107","article-title":"Ascites, but not hyponatremia, is associated with high intraoperative transfusion and vasopressor requirements during liver transplantation","volume":"38","author":"Xia","year":"2006","journal-title":"Transplant. Proc."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"2857","DOI":"10.1016\/j.transproceed.2012.09.085","article-title":"Risk factors for bleeding and clinical implications in patients undergoing liver transplantation","volume":"44","author":"Pirenne","year":"2012","journal-title":"Transplant. Proc."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/13\/19\/5776\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T16:05:13Z","timestamp":1760112313000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/13\/19\/5776"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,9,27]]},"references-count":33,"journal-issue":{"issue":"19","published-online":{"date-parts":[[2024,10]]}},"alternative-id":["jcm13195776"],"URL":"https:\/\/doi.org\/10.3390\/jcm13195776","relation":{},"ISSN":["2077-0383"],"issn-type":[{"type":"electronic","value":"2077-0383"}],"subject":[],"published":{"date-parts":[[2024,9,27]]}}}