Evaluation of the correlation between six scoring systems for assessing the severity of end-stage liver disease and intraoperative blood loss during liver transplantation: a retrospective study

Clinical Transplantation and Research, vol. 39, pp. 124–130

Abstract

Background: Patients with end-stage liver disease (ESLD) are particularly susceptible to intraoperative hemorrhage during liver transplantation (LT), a risk partly attributable to coagulopathy. Various scoring systems are used to assess ESLD severity and predict waitlist mortality for LT. However, the potential association between ESLD severity and intraoperative blood loss remains underexplored. Therefore, we investigated the relationship between six widely utilized ESLD scoring systems and intraoperative blood loss during LT. Methods: We conducted a retrospective chart review of all adult patients who underwent LT at a single center between 2011 and 2021. Results: ). The mean estimated blood loss volume (eBLV) was 3,292 mL (SD, 4,232 mL), leading to a cumulative transfusion volume (TxV) of 2,695 mL (SD, 3,288 mL), which included both homologous and cell-salvaged blood. On average, 6.49 units of homologous packed red blood cells were transfused. All six ESLD scoring systems and their constituent parameters exhibited weak positive correlations with both eBLV and TxV; notably, Model for End-Stage Liver Disease-Sodium (MELD-Na) showed the strongest correlation (R=0.265, P<0.001), while UKELD (UK MELD) showed the weakest (R=0.088, P=0.018). Conclusions: Although statistically significant, the predictive power of ESLD scoring systems for blood loss during LT was generally weak. This finding suggests the need for further research to develop a scoring system specifically tailored for this purpose.

Authors 8

1. Amer Majeed corresponding

   King Faisal Specialist Hospital & Research Centre

   Affiliation as printed

   Section of Abdominal Transplant Anesthesiology, Organ Transplant Center of Excellence, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia

2. Noon E. Abdelgadir

   Alfaisal University

   Affiliation as printed

   College of Medicine, Alfaisal University, Riyadh, Saudi Arabia

3. Momina Amer Aachen Department of Social and Behavioral Sciences

   Leiden University

   Affiliation as printed

   Department of Social and Behavioral Sciences, Leiden University, Leiden, Netherlands

4. Mohammed E. Ibrahim

   University Hospitals of North Midlands NHS Trust

   Affiliation as printed

   Department of Anaesthesia, University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, UK

5. Mohamad S. Nagy

   St. Jude Children's Research Hospital

   Affiliation as printed

   Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN, USA

   Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN, USA

6. Bilal Tufail

   Montefiore Medical Center

   Affiliation as printed

   Department of Anesthesiology, Montefiore Medical Center, New York, NY, USA

7. Luluah Altukhaifi

   King Faisal Specialist Hospital & Research Centre

   Affiliation as printed

   Department of Epidemiology and Biostatistics, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia

8. Areej A. G. AlFattani

   King Faisal Specialist Hospital & Research Centre

   Affiliation as printed

   Department of Epidemiology and Biostatistics, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia