TY - JOUR
T1 - Ultra-massive fluid transfusion in adult liver transplant recipients
T2 - A single center observational study
AU - Slifirski, Hugh
AU - Raykateeraroj, Nattaya
AU - Armellini, Angelica
AU - Hazard, Riley
AU - Zalcman, Jordan
AU - Zhao, Junyan
AU - Tran, Zac
AU - Le, Peter
AU - Zhang, Wendell
AU - Fink, Michael
AU - Perini, Marcos Vinicius
AU - Koshy, Anoop N.
AU - Lee, Dong Kyu
AU - Weinberg, Laurence
N1 - Publisher Copyright:
© 2025 Slifirski et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
PY - 2025/6
Y1 - 2025/6
N2 - Introduction Patients undergoing liver transplantation may require large volumes of fluid to maintain hemodynamic stability and treat coagulopathy. This study aimed to determine the prevalence of ultra-massive fluid transfusion and to examine its association with clinical outcomes. We defined an ultra-massive fluid transfusion a priori as a transfusion volume of >20 liters of crystalloids, colloids, blood and blood products administered intraoperatively and within the first 24 hours postoperatively. Methods This single-center retrospective observational study included all adult patients who underwent an orthotopic liver transplant and received an ultra-massive fluid transfusion. The primary aim was to determine the prevalence of ultra-massive fluid transfusion in patients undergoing liver transplantation. Secondary objectives included evaluating the effect of the total volume of fluid and packed red blood cell transfusions on postoperative complications, mechanical ventilation hours, intensive care unit and hospital length of stay, and mortality. Results Of the 844 liver transplantation procedures, 81 (9.6%) required an ultra-massive fluid transfusion with a median transfusion volume of 36.8 liters (IQR: 31.2–48.7). Each additional liter of fluid administered during surgery was associated with an additional stay of 0.47 days in intensive care (95%CI: 0.18–0.76, p = 0.003). Each additional unit of packed red blood cells administered during surgery was associated with an additional 12.8 hours of mechanical ventilation (95%CI: 3.12–22.43, p = 0.014) and 1.0 additional day in intensive care (95%CI: 0.27–1.79, p = 0.012). Neither ultra-massive fluid transfusion nor packed red blood cell transfusions were associated with increased complications. Conclusion Approximately one in ten liver transplantation patients required an ultra-massive fluid transfusion. While ultra-massive fluid transfusion was associated with prolonged recovery, it was not associated with an increased risk of complications or mortality.
AB - Introduction Patients undergoing liver transplantation may require large volumes of fluid to maintain hemodynamic stability and treat coagulopathy. This study aimed to determine the prevalence of ultra-massive fluid transfusion and to examine its association with clinical outcomes. We defined an ultra-massive fluid transfusion a priori as a transfusion volume of >20 liters of crystalloids, colloids, blood and blood products administered intraoperatively and within the first 24 hours postoperatively. Methods This single-center retrospective observational study included all adult patients who underwent an orthotopic liver transplant and received an ultra-massive fluid transfusion. The primary aim was to determine the prevalence of ultra-massive fluid transfusion in patients undergoing liver transplantation. Secondary objectives included evaluating the effect of the total volume of fluid and packed red blood cell transfusions on postoperative complications, mechanical ventilation hours, intensive care unit and hospital length of stay, and mortality. Results Of the 844 liver transplantation procedures, 81 (9.6%) required an ultra-massive fluid transfusion with a median transfusion volume of 36.8 liters (IQR: 31.2–48.7). Each additional liter of fluid administered during surgery was associated with an additional stay of 0.47 days in intensive care (95%CI: 0.18–0.76, p = 0.003). Each additional unit of packed red blood cells administered during surgery was associated with an additional 12.8 hours of mechanical ventilation (95%CI: 3.12–22.43, p = 0.014) and 1.0 additional day in intensive care (95%CI: 0.27–1.79, p = 0.012). Neither ultra-massive fluid transfusion nor packed red blood cell transfusions were associated with increased complications. Conclusion Approximately one in ten liver transplantation patients required an ultra-massive fluid transfusion. While ultra-massive fluid transfusion was associated with prolonged recovery, it was not associated with an increased risk of complications or mortality.
UR - https://www.scopus.com/pages/publications/105008516680
U2 - 10.1371/journal.pone.0325829
DO - 10.1371/journal.pone.0325829
M3 - Article
C2 - 40526696
AN - SCOPUS:105008516680
SN - 1932-6203
VL - 20
JO - PLoS ONE
JF - PLoS ONE
IS - 6 June
M1 - e0325829
ER -