Abstract: Objective To evaluate an improved massive transfusion protocol (MTP) to reduce transfusion and complications in orthotopic liver transplantation (OLT) at a single institution. Methods We retrospectively studied the massive ransfusion patients who underwent OLT at the Second Xiangya Hospital of Central South University from January 2016 to December 2022, enrolled 146 baseline data-matched cases (73 in improved MTP group and 73 in initial MTP group) by propensity-matched analysis, and compared the intraoperative transfusion profiles, laboratory and clinical outcomes and prognosis. Results Improved MTP decreased the intraoperative erythrocyte transfusion, increased apheresis platelet and cryoprecipitate transfusion, and plasma/platelet to red blood cell (RBC) transfusion ratios (P<0.05), but there was no statistically significant difference in plasma transfusion between the two groups (P>0.05). In improved MTP group, the level of Hb, PLT, FIB and TT were significantly increased (P<0.05), PT was significantly decreased (P<0.05), the renal markers (CREA and UREA) elevated values and in-hospital mortality rate were significantly lower (P<0.05). Conclusion In OLT, the improved MTP can reduce unnecessary blood transfusion and improve transfusion efficacy.

Key words: Orthotopic liver transplantation, Massive transfusion protocol, Transfusion safety, Propensity matching