Evaluation of correlation between etiology of end stage liver disease and intraoperative utilization of blood products during liver transplantation

Background: Liver transplantation is frequently associated with massive blood loss and utilization of blood products to optimize coagulation; this study aimed to evaluate their possible correlation with etiological and perioperative factors. Methods: A retrospective analysis of adult liver transplant (LT) recipients (excluding re-do transplants) operated upon at our center between 2011 and 2021 was conducted using R package with rBiostatistics.com graphical user interface. Results: Of the 947 cases, 70.70% had cirrhosis, and 28.6% hepatocellular carcinoma, as secondary diagnoses; the most common primary diagnosis was viral hepatitis (B = 20.9% and C = 20.0%). The mean blood loss volume was 3393.2 ml. Living donor liver transplantation (LDLT) recipients (n = 740, 78.2%) had lesser blood loss (mean difference 738 mL, P = 0.037) and reduced requirement for fresh frozen plasma (FFP, OR = 0.734, P = 0.001) and platelets (OR = 0.809, P < 0.001). Presence of hepatocellular carcinoma (n = 273, 28.6%) was significantly protective for blood loss (mean difference 717 ml, P = 0.037) and the need for FFP (OR = 0.991, P < 0.001), cryoprecipitate (OR = 0.568, P = 0.001), and platelets (OR = 0.602, P < 0.001). Schistosomiasis ( n = 23, 2.4%) was accompanied by increased blood loss (mean difference 2328 ml ( P = 0.012)). A body mass index (BMI) >35 kg/m 2 increased the hazard of cryoprecipitate requirement (OR = 1.203, P = 0.008). Conclusion: The blood loss and the blood products transfusion requirements in LT are influenced by the etiology, graft type, and other perioperative factors such as BMI.