Intraoperative blood loss during living donor liver transplantation: an analysis of 635 recipients at a single center.

Yuasa T, Niwa N, Kimura S, et al.
Transfusion 2005;45(6):879-884.
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Retrospective analysis of the relationship between various clinical factors
including blood transfusion and survival in living donor liver transplantation. The
conclusion is that massive blood loss significantly reduces survival and is a
predictor of poor prognosis, and therefore minimizing of intraoperative blood
loss would improve prognosis. On the other hand, the high-blood-loss group had
significantly lower hematocrit values, higher bilirubin, bun and CRP levels, and
the average duration of the surgery was about 150 min longer. Therefore, bias and confounding clearly reduce the strength of the conclusion because the patients of the high-blood-loss group were obviously more difficult and
more ill, and thus reduction of blood loss was certainly not possible. In any case, one cannot conclude from the results that the poor prognosis was caused by transfusions.

– Volker Kretschmer