13 January 2026 : Original article
Excessive Intraoperative Blood Loss Increases the Risk of Postoperative Complications After Liver Transplantation: A Retrospective Multicenter Study
Yao Fu EF 1, Ze-Liang Xu AC 1, Lei-Da Zhang A 1, Cheng-Cheng Zhang A 1, Qing-Yi Zhang A 1, Xing-Chao Liu BD 2, Yi Zhang BD 3, Zhu Li BD 4, Shao-Hua Song BD 5, Di Jiang
ADEFG 1*
DOI: 10.12659/AOT.950496
Ann Transplant 2026; 31:e950496
Table 1 Baseline characteristics of included donors and recipients.
| Characteristic | Total (n=822) | Intraoperative blood loss <1000 mL (n=402) | Intraoperative blood loss ≥1000 mL (n=420) | P value |
|---|---|---|---|---|
| Age, years | 48 (39–56) | 49 (39–56) | 48 (39–56) | 0.640 |
| Sex, male | 648.0 (78.8) | 315.0 (78.4) | 333.0 (79.3) | 0.740 |
| BMI, kg/m | 23.3 (21.9–25.3) | 23.3 (21.6–25.0) | 23.4 (22.0–25.4) | 0.300 |
| Age, years | 50.0 (42.0–57.0) | 51.0 (41.0–58.0) | 50.0 (42.0–56.0) | 0.480 |
| Sex, Male | 677.0 (82.4) | 342.0 (85.1) | 335.0 (79.8) | 0.460 |
| BMI, kg/m | 23.4 (21.2–25.4) | 23.4 (21.2–25.4) | 23.4 (21.2–25.2) | 0.826 |
| Viral hepatitis | 310.0 (37.7) | 138.0 (34.3) | 172.0 (41.0) | 0.040 |
| Tumor | 335.0 (40.8) | 188.0 (46.8) | 147.0 (35.0) | |
| Autoimmune disease | 39.0 (4.7) | 20.0 (5.0) | 19.0 (4.5) | |
| Other | 138.0 (16.8) | 56.0 (13.9) | 82.0 (19.5) | |
| ABO incompatibility | 22.0 (2.7) | 7.0 (1.7) | 15.0 (3.6) | 0.100 |
| MELD score | 14.0 (9.2–20.7) | 12.8 (8.6–19.7) | 14.6 (10.0–22.1) | 0.001 |
| Hypertension | 83.0 (10.1) | 44.0 (10.9) | 39.0 (9.3) | 0.430 |
| Refractory ascites | 340.0 (41.3) | 155.0 (38.6) | 185.0 (44.0) | 0.110 |
| PMAS | 86.0 (10.4) | 33.0 (8.2) | 53.0 (12.6) | 0.03 |
| ASA score ≥3 | 613 (74.6) | 299 (48.8) | 314 (51.2) | 0.899 |
| Pre-LT ICU stay | 101 (12.3) | 30 (7.5) | 71 (16.9) | <0.001 |
| Portal hypertension | 469 (57.1) | 232 (57.7) | 237 (56.4) | 0.710 |
| Preop. ETI | 15 (1.8) | 4 (1.0) | 11 (2.6) | 0.082 |
| Child-Pugh score | 10.0 (9.0–12.0) | 10.0 (9.0–12.0) | 10.0 (9.0–12.0) | 0.368 |
| WBC, 10/L | 4.3 (3.0–6.4) | 4.2 (3.0–6.1) | 4.5 (3.0–7.1) | 0.130 |
| HGB, g/L | 108 (88–132) | 116 (95–136) | 104 (83–125) | <0.010 |
| PLT,10/L | 66.0 (43.0–111.2) | 71.0 (47.7–115.2) | 62.0 (40.2–110.7) | 0.020 |
| ALT, IU/L | 38.0 (24.0–70.0) | 39.0 (24.0–70.2) | 37.0 (24.0–70.0) | 0.920 |
| ALB, g/L | 35 (31–40) | 36 (32–42) | 34 (30–39) | <0.010 |
| TB, μmol/L | 55.0 (23.7–172.0) | 46.0 (21.0–154.0) | 63.0 (27.0–195.5) | <0.010 |
| INR | 1.3 (1.0–1.8) | 1.1 (1.0–1.7) | 1.4 (1.0–2.0) | <0.010 |
| Sodium, mmol/L | 138.4 (136.0–141.0) | 138.4 (136.1–141.0) | 138.3 (135.9–141.0) | 0.061 |
| Potassium, mmol/L | 3.9 (3.6–4.2) | 3.9 (3.6–4.2) | 3.9 (3.6–4.2) | 0.928 |
| Creatinine, μmol/L | 67.7 (56.7–82.5) | 68.0 (57.3–80.9) | 67.0 (55.2–84.7) | 0.95 |
| BMI – body mass index; MELD – Model for End-Stage Liver Disease; PMAS – previous major abdominal surgery; ASA – American Society of Anesthesiologists; Pre-LT ICU stay – pre–liver transplantation intensive care unit stay; Preop. ETI – preoperative endotracheal intubation; WBC – white blood cell count; HGB – hemoglobin; PLT – platelets; ALT – alanine aminotransferase; ALB – albumin; TB – total bilirubin; INR – international normalized ratio. Continuous variables are expressed as median (interquartile range). Categorical variables are expressed as counts and percentages (n,%). | ||||