Intraoperative allogeneic blood transfusion is not associated with postoperative acute kidney injury and in-hospital mortality in liver transplantation patients: a propensity score matching analysis.
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BACKGROUND: Many studies have found a correlation between perioperative blood transfusion and postoperative complications and mortality in liver transplant (LT) patients. The purpose of our study is to identify independent risk factors for intraoperative blood transfusion in liver transplant patients and to explore the effect of intraoperative blood transfusion on postoperative acute kidney injury (AKI) and in-hospital mortality in LT patients. METHODS: A total of 686 liver transplant patients were included in the study, of which 517 (75.4%) patients received an intraoperative blood transfusion (IBT group). Univariable and multivariable regression were used to identify independent risk factors for IBT, and propensity score matching (PSM) and multivariable regression analysis were used to analyze the effect of IBT on postoperative AKI and in-hospital mortality. RESULTS: The multivariable regression analysis revealed that sex (p = 0.044), weight (p = 0.005), liver cancer (p = 0.003), alcoholic hepatitis (p = 0.048), Child-Pugh classification (p = 0.006), anhepatic phase (p = 0.044), and intraoperative bleeding (p < 0.0001) were independent risk factors for IBT. In the unmatched cohort, IBT was significantly associated with an increased risk of post-LT AKI (OR 2.993, 95% CI 2.061-4.347, p < 0.0001) and in-hospital mortality (OR 2.692, 95% CI 1.313-5.522, p = 0.007). After multivariable logistic regression, IBT remained an independent risk factor for both post-LT AKI and in-hospital mortality in the unmatched cohort. After propensity score matching, 105 pairs of patients were obtained. Among the 105 patients who received IBT, the vast majority, 97 patients (92.4%), received no more than 8 units of blood. In the matched cohort, IBT was significantly associated with an increased risk of post-LT AKI (OR: 1.861, 95% CI: 1.053-3.290, p = 0.033), but not associated with in-hospital mortality (OR: 1.000, 95% CI: 0.281-3.562, p = 1.000). After multivariable regression analysis, IBT was no longer an independent risk factor for post-LT AKI and hospital mortality in the matched cohort. CONCLUSION: In our matched cohort, the vast majority of patients, received no more than 8 units of blood. Intraoperative allogeneic blood transfusion does not influence postoperative acute kidney injury and in-hospital mortality in liver transplantation patients. Multicenter, prospective studies are needed in the future to validate our findings. CLINICAL TRIAL REGISTRATION: CHiCTR1900024561; https://www.chictr.org.cn/showproj.html?proj=41126.