Evaluation of the correlation between six scoring systems for assessing the severity of end-stage liver disease and intraoperative blood loss during liver transplantation: a retrospective study.

Abstract

Background: Patients with end-stage liver disease (ESLD) are particularly susceptible to intraoperative hemorrhage during liver transplantation (LT), a risk partly attributable to coagulopathy. Various scoring systems are used to assess ESLD severity and predict waitlist mortality for LT. However, the potential association between ESLD severity and intraoperative blood loss remains underexplored. Therefore, we investigated the relationship between six widely utilized ESLD scoring systems and intraoperative blood loss during LT.

Methods: We conducted a retrospective chart review of all adult patients who underwent LT at a single center between 2011 and 2021.

Results: A total of 719 adult patients were included, with a male-to-female ratio of 2:1. The mean age was 53.9 years (standard deviation [SD], 13.5 years), and the average body mass index was 26.9 kg/m² (SD, 5.5 kg/m²). The mean estimated blood loss volume (eBLV) was 3,292 mL (SD, 4,232 mL), leading to a cumulative transfusion volume (TxV) of 2,695 mL (SD, 3,288 mL), which included both homologous and cell-salvaged blood. On average, 6.49 units of homologous packed red blood cells were transfused. All six ESLD scoring systems and their constituent parameters exhibited weak positive correlations with both eBLV and TxV; notably, Model for End-Stage Liver Disease-Sodium (MELD-Na) showed the strongest correlation (R=0.265, P<0.001), while UKELD (UK MELD) showed the weakest (R=0.088, P=0.018).

Conclusions: Although statistically significant, the predictive power of ESLD scoring systems for blood loss during LT was generally weak. This finding suggests the need for further research to develop a scoring system specifically tailored for this purpose.