Liver transplantation may be complicated by massive intraoperative
bleeding, and red blood cell (RBC) transfusions may be required. The storage duration or age of transfused RBCs has been shown to affect the morbidity and mortality of
critically ill,
trauma, and cardiac surgery patients. Here we investigate the effect of RBC age on the outcomes of
liver transplant patients. Five hundred thirty-one patients underwent orthotopic
liver transplantation between January 1, 2000 and August 15, 2010. The patient demographics, the Model for
End-Stage Liver Disease-
sodium (MELD-Na) score, and the number and age of RBC units were evaluated with univariate and multivariate models of outcomes, which included mortality rates 2 years after
transplantation, postoperative
infections, and organ rejection. In a univariate analysis, the number of RBC units (but not the RBC age) was associated with increased 2-year mortality, an increased risk of
infection, and a decreased risk of organ rejection. Only the number of RBC units was associated with increased 2-year mortality in a multivariate Cox regression model. The mortality risk was decreased by two-thirds for patients who received <10 U of RBCs versus those who received ≥10 U (hazard ratio = 0.33, 95% confidence interval = 0.16-0.69, P = 0.003). The number of transfused RBC units was not associated with the risk of
infection or organ rejection in a multivariate logistic regression model. In conclusion, the RBC age is not associated with
infection, organ rejection, or death in
liver transplant patients. Patients who receive more blood have an increased risk of death. In a multivariate model, the MELD-Na score was not associated with increased mortality, and this is consistent with previous studies demonstrating that the MELD-Na score is a poor predictor of long-term survival after
transplantation.