Excessive Intraoperative Blood Loss Increases the Risk of Postoperative Complications After Liver Transplantation: A Retrospective Multicenter Study

BACKGROUND Liver transplantation (LT) involves substantial intraoperative blood loss and postoperative complications, yet the relationship between these factors remains incompletely defined. This study aimed to evaluate the impact of excessive intraoperative blood loss (EIBL) on postoperative complication rates. MATERIAL AND METHODS We enrolled adult patients who underwent liver transplantation at 5 centers from January 2015 to June 2024. Patients were categorized into EIBL (blood loss ≥1000 mL) and non-EIBL groups. Univariate and multivariate logistic regression analyses were performed to identify EIBL risk factors and to assess its effect on postoperative complications, with adjustment for confounders such as age, sex, and comorbidities. Risk factors for specific complications were also examined. RESULTS In total, 822 patients were included. Univariate and multivariate logistic regression analyses indicated that benign disease, previous major abdominal surgery, pre-LT intensive care unit stay, and preoperative albumin below 38 g/L were independent risk factors for EIBL. EIBL was significantly associated with postoperative biliary complications and severe complications (Clavien-Dindo grade ≥3). Further regression confirmed EIBL as an independent risk factor for biliary complications (P=0.034) and Clavien-Dindo grade 3 or higher complications (P=0.042). Kaplan-Meier analysis showed that the 5-year survival rate was significantly lower in the EIBL group than in the non-EIBL group (P=0.010). CONCLUSIONS Comprehensive preoperative assessment and meticulous surgical practice can reduce EIBL risk, thereby decreasing postoperative complications after LT and improving long-term survival.