Preoperative predictors of massive intraoperative bleeding in liver transplant recipients: A retrospective analysis

Despite rapid advancements in orthotopic liver transplantation over the past decade, massive intraoperative bleeding (MIB) remains a significant surgical risk for patients. Identifying predictive factors for MIB can optimize preoperative and intraoperative management. We analyzed the predictive value of preoperative laboratory indicators for MIB in liver transplant patients, evaluating their intraoperative blood loss. We collected clinical data from 158 patients who underwent their first liver transplantation between May 1, 2022, and April 30, 2024. Patients were divided into MIB (experimental group: ≥800 mL) and non-MIB (control group: <800 mL) groups based on intraoperative blood loss. We analyzed the correlation between preoperative laboratory indicators and baseline data with massive bleeding. Statistical analyses were performed using the Statistical Package for the Social Sciences software (version 25.0). This study found that the preoperative indices alanine aminotransferase (ALT), aspartate transaminase (AST), total bilirubin, direct bilirubin, albumin (ALB), hemoglobin, hematocrit, prothrombin time, thrombin time, and fibrinogen significantly influenced MIB (P < .05). Multivariate logistic regression analysis identified ALT and AST as independent risk factors for intraoperative bleeding (P < .05). Receiver operating characteristic curve analysis revealed areas under the curve of 0.619 (95% confidence interval [CI]: 0.528-0.709) for ALT and 0.684 (95% CI: 0.600-0.767) for AST in MIB prediction. In this study, preoperative ALT and AST were identified as risk factors for MIB during liver transplantation, aiding in the development of a predictive model for intraoperative bleeding risk.