Predictors of blood transfusion requirement in elective liver resection


  • Presented at the 9th Annual Meeting of the American Hepato-Pancreato-Biliary Association, 12–15 March 2009, Miami, FL, USA.

K. Raj Prasad, Consultant Hepatobiliary and Transplant Surgeon, Department of Hepatobiliary and Transplant Surgery, St James's University Hospital, Leeds, LS9 7TF, UK. Tel: +44 (0)113 2065921; Fax: +44 (0)113 2448182; E-mail:


Background:  Liver resection remains major surgery frequently requiring intra-operative blood transfusion. Patients are typically over cross-matched, and with blood donor numbers falling, cross-matching and transfusion policies need rationalizing.

Aim:  To identify predictors of peri-operative blood transfusion.

Methods:  A retrospective review of elective hepatic resections over a 4-year period was performed. Twenty-six variables including clinicopathological variables and intra-operative data were collated, together with the number of units of blood cross-matched and transfused in the immediate peri-operative period (48 h). Multivariate regression analysis was performed to identify independent predictors of blood transfusion, and a Risk Score for transfusion constructed.

Results:  Five hundred and eighty-nine patients were included in the study, and were cross-matched with a median 10 units of blood. Seventeen per cent of patients received a blood transfusion; median transfusion when required was 2 units. Regression analysis identified seven factors predictive of transfusion: haemoglobin <12.5 g/dL, pre-operative biliary drainage, coronary artery disease, largest tumour >3.5 cm, cholangiocarcinoma, redo resection and extended resection (5+ segments). Patients were stratified into high or low risk of transfusion based on Risk Score with a sensitivity of 73% [receiver-operating characteristic (ROC) 0.77].

Conclusions:  Patients undergoing elective liver resection are over-cross-matched. Patients can be classified into high and low risk of transfusion using a Risk Score, and cross-matched accordingly.