Ultra-massive fluid transfusion in adult liver transplant recipients: A single center observational study

PMCID: PMC12173374

PMID: 40526696

DOI: 10.1371/journal.pone.0325829

Journal: PloS one

Publication Date: 2025-6-17

Authors: Slifirski H, Raykateeraroj N, Armellini A, Hazard R, Zalcman J, et al.

Key Points

• Approximately 1 in 10 liver transplant patients require ultra-massive fluid transfusion (>20 liters)
• Each additional PRBC unit was associated with 12.8 hours more mechanical ventilation (95%CI: 3.12-22.43, p=0.014)
• Extensive fluid resuscitation can be safely managed without increasing complication risks in liver transplantation

Summary

This single-center retrospective study examined ultra-massive fluid transfusion (UMFT) in liver transplantation, defining UMFT as >20 liters of fluid administered intraoperatively and within 24 hours postoperatively. Among 844 liver transplant procedures, 81 patients (9.6%) required UMFT, with a median transfusion volume of 36.8 liters. The study revealed significant associations between fluid and blood product volumes and patient recovery metrics.

Each additional liter of fluid was associated with a 0.47-day increase in intensive care unit (ICU) length of stay, while each additional packed red blood cell (PRBC) unit correlated with 12.8 more hours of mechanical ventilation and 1.0 additional ICU day. Notably, despite the substantial fluid volumes, UMFT was not associated with increased postoperative complications or mortality, suggesting that careful fluid management can support hemodynamic stability during complex liver transplantation procedures.