In this study we sought to determine the factors influencing red blood cell (RBC) transfusions and to study the transfusion practice of anesthesiologists during liver transplants. A retrospective study of 206 successive liver transplants was undertaken during a period of 52 mo. Transfused blood products were identified. Twenty variables were analyzed in a univariate fashion. For the multivariate analysis, the cases were divided in 2 subgroups: more than 4 RBC units transfused and 4 or less RBC units transfused. The average number of RBC units transfused during a liver transplant was 2.8 (+/- 3.5) per patient, 32.0% did not receive any RBC, and 19.4% did not receive any blood products during the transplant. Three variables were related to the number of RBC units transfused: the starting International Normalized Ratio value, the starting platelet count, and the duration of surgery. We found that there was a wide difference in the transfusion practice of the anesthesiologists involved in this series of liver transplants. It was difficult to identify predictive factors for RBC transfusions when the transfusion rate was small and because of the variability in human factors. Plasma transfusion did not decrease the rate of RBC transfusions; sometimes it was the contrary.
Implications: This is a retrospective study of 206 liver transplants over 52 mo to identify the predictive factors of red blood cell transfusions and the anesthesiologists' transfusion strategies. We conclude that there is a wide difference in transfusion practices among anesthesiologists.