Abstract: Objective To analyze the high risk factors of massive intraoperative blood transfusion,we summarized the clinical data of pediatric living donor liver transplantation (LDLT) in a single center. Methods A retrospective analysis of 140 children aged from 3 months to 12 years who underwent living donor liver transplantation in Children's Hospital of Chongqing Medical University from June 2018 to December 2021. All patients received intraoperative red blood cell transfusion. According to intraoperative red blood cell transfusion volume, they were divided into massive blood transfusion group (>70 mL/kg,30/140,21.4%) and non-massive transfusion group (≤70 mL/kg,110/140,78.6%). Baseline data, preoperative laboratory parameters and intraoperative variables were compared between the two groups. Results Univariate Logistic analysis showed that there were significant differences between the two groups in weight, PELD score, operation time, total bilirubin, international normalized ratio INR, white blood cells, APTT, TT, and history of upper abdominal surgery (P<0.05). Multivariate Logistic regression analysis using receiver-operating characteristics Characteristic( ROC) curve, and using indices to determine cutoff values found low body weight (<6.35 kg), high PELD score (>9.5), long operation time (>466.5 min) and history of upper abdominal surgery were independent risk factors for massive blood transfusion in children with living donor liver transplantation. The area under the curve (AUC) of the combined four-factors prediction was 0.854, which was more sensitive and specific than the single prediction. Conclusion sChildren with lower preoperative weight,a history of upper abdominal surgery,and a higher pediatric end-stage liver disease model score were more likely to receive intraoperative massive blood transfusion, and increased operation time would further increase the risk of massive blood transfusion. Meanwhile, high preoperative white blood cell count, low coagulation function and high bilirubin are risk factors for massive intraoperative blood transfusion.

Key words: Pediatric liver transplantation, Massive blood transfusion, Living donor liver, Risk factors