A prospective study investigating the cost effectiveness of intraoperative blood salvage during liver transplantation

Background. Adult orthotopic liver transplantation is associated with significant use of allogenic blood products, which places considerable demands on finite resources. This could be reduced by autologous red cell salvage use, and we evaluated its cost effectiveness in this prospective study. Methods. Intraoperative autotransfusion was used in 660 adult liver transplant patients between January 1997 and July 2002. These included 134 with acute liver failure, 62 retransplants, 90 alcohol-related, 183 viral, 98 cholestatic chronic liver diseases, and 93 with other etiologies. Results. The total volume of red blood cells transfused was 3641 +/- 315 ml, 2805 +/- 234 ml, 2603 +/- 443 ml, and 2785 +/- 337 nil for alcohol-related, viral, cholestatic, and others, respectively. Low preoperative hemoglobin was significantly associated with higher intraoperative transfusion requirements. Blood volumes transfused at retransplantation were significantly higher (7077 1110 nil vs. 2864 138 ml; P < 0.001) than for acute liver failure and chronic liver disease. Autologous blood volumes transfused were similar in all diagnostic groups, but were significantly greater in retransplantation (2754 +/- 541 ml vs. 1524 +/- 77 ml; P < 0.01). Venovenous bypass was significantly associated with higher transfusion requirements. Total savings per case were similar for all diagnostic groups but were greater in cases of retransplantation (POUND864 +/- 222 ($1235 +/- 317) vs. POUND238 +/- 24 ($340 +/- 34; P < 0.001). With the use of autologous transfusion over the study period, a cost saving of POUND31,901 ($188,618) was achieved. Conclusions. Intraoperative red blood cell salvage and autologous transfusion is cost effective in adult liver transplantation. Currently, where optimum resource utilization and fiscal constraint are paramount in healthcare delivery, autologous transfusion is an important adjunct in liver transplantation.