JHBPS: Relationship between red blood cell distribution width and blood transfusion in living donor liver transplant patients: a propensity score analysis

Liver transplantation (LT) is one of the most complex procedures for patients with end-stage liver disease and presents a huge challenge for surgeons and anesthesiologists
.
Despite efforts to find predictors of bleeding and transfusion in liver transplantation, limited information is currently available
.
Red blood cell distribution width (RDW), which is part of measuring changes in red blood cell size in blood samples and a standard complete blood count, has been reported in several recent studies to be associated with bleeding risk and transfusion in certain diseases and procedures
.

However, information on predictors of blood transfusion in living donor liver transplantation (LDLT) is limited
.
This study investigated the relationship between red blood cell distribution width (RDW) and intraoperative blood transfusion in LDLT recipients
.

This study analyzed 2546 patients who received LDLT between January 2010 and October 2019
.
Patients were divided into two groups according to preoperative RDW cutoff levels (<14.
4 and ≥14.
4)
.
We performed multivariate regression analysis to assess the association between RDW and intraoperative blood transfusion, and propensity score matching to compare the incidence of intraoperative blood transfusion between the two groups
.
The predictive power of RDW was assessed by receiver operating characteristic (ROC), integrated discrimination improvement (IDI), and net reclassification improvement (NRI) analyses
.

Figure 1: ROC curve of red blood cell distribution width during intraoperative blood transfusion in living donor liver transplant patients

Table 1: Intraoperative Transfusion Adjusted RDW Cutoff Level (≥14.
4)

Table 2: The added value of evaluating RDW for predicting intraoperative blood transfusion.
*Model 1=age+sex+BMI+DM+HTN+laparotomy history+CAD+portal vein thrombosis+ascites+MELD score+etiology+HCC+hemoglobin<12+INR >1.
3+platelets<70k+fibrinogen<160
.
†Model 2=Model 1+RDW≥14.
4

In multivariate logistic analysis, RDW  ≥ 14.
4 was significantly associated with intraoperative blood transfusion (odds ratio [OR]: 1.
53, 95% confidence interval [CI]: 1.
13-2.
06, P  = 0.
005)
.
 There was a statistically significant difference in the incidence of intraoperative blood transfusion between the two groups before matching (54.
1% vs.
91.
6%, P  < 0.
001) and after matching (71.
6% vs.
79.
8%, P
= 0.
004) .
RDW had predictive power for intraoperative blood transfusion (P < 0.
001 for NRI, P = 0.
035 for IDI ) .

Overall, the researchers found that preoperative RDW ≥14.
4 was strongly associated with intraoperative blood transfusion in patients with LDLT
.
These results suggest that preoperative RDW may serve as a useful predictor of intraoperative blood transfusion in LDLT recipients
.

Original source:

Sim, J.
-H.
, Kwon, H.
-M.
, Jun, I.
-G.
, Kim, S.
-H.
, Kim, B.
, Kim, S.
, Song, J.
-G.
and Hwang, G.
-S.
(2022), Association between red blood cell distribution width and blood transfusion in patients undergoing living donor liver transplantation: propensity score analysis.
J Hepatobiliary Pancreat Sci.
Accepted Author Manuscript.
https://doi.
org/ 10.
1002/jhbp.
1163.