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Reuters Health Information (2011-12-05): Albumin on POD 2 indicates need for FFP after liver surgery: study


Albumin on POD 2 indicates need for FFP after liver surgery: study

Last Updated: 2011-12-05 16:15:30 -0400 (Reuters Health)

NEW YORK (Reuters Health) - Japanese researchers say liver resection patients won't need fresh frozen plasma if their albumin level is above 2.4 g/dL by postoperative day two.

With this guideline they were able "to reduce the transfusion rate from 49% to 1% in patients undergoing liver resection," Dr. Tadatoshi Takayama told Reuters Health by email.

"In many countries including Japan, surgeons are willing to use a great deal of blood products... based on the retrospective data," Dr. Tadatoshi Takayama said. "Now we have defined the transfusion criteria by a prospective study."

This month in Archives of Surgery, Dr. Takayama of Nihon University School of Medicine in Tokyo and colleagues report on their study of 172 patients who had surgery for liver cancer. All had Child-Pugh class A liver function and an intraoperative blood loss of less than 1000 mL

The starting "no-transfusion" threshold was a serum albumin level of 3 g/dL on postoperative day two. This threshold was reduced by 0.2 g/dL in subsequent steps as the study progressed.

"Advancement to the next step was permitted when the albumin level equaled the target value for the previous step in 3 patients," the authors said. For example,

if the albumin value on postoperative day 2 fell below the target value, 100 mL of albumin, 25%, was transfused on that day and on postoperative day 3.

Step progression was broken off at step 5 in the 172nd patient because the postoperative day 2 albumin value did not fall below the step 4 level (2.4 g/dL).

Overall, only one patient needed FFP transfusion to treat intractable ascites. Twenty patients (11.6%) received albumin solution according to the protocol.

No patient died, and the postoperative morbidity was 27.9%. Comparison with 222 historical controls showed that the FFP transfusion rate fell from 48.6% to 0.6%. In the earlier cohort, most of the transfusions took place on the day of operation or the following day to compensate for the decrease in the serum albumin level caused by intraoperative blood loss.

Postoperative hospital stay was significantly shorter in the current patients (13 vs 16 days) and median medical costs were significantly less ($17,267 vs $21,061).

The researchers say they expect their findings "to provide the basis for developing optimal criteria for the use of FFP transfusion and to contribute to avoiding the unnecessary use of FFP in liver resection."

Commenting in an editorial, Dr. Steven D. Colquhoun of Cedars-Sinai Medical Center, Los Angeles observes that the investigators have "given us a discrete threshold for the use of FFP. This new guideline will avoid needless use of FFP, reducing risk and expense."

The study was supported by the 106th Annual Congress of Japan Surgical Society Memorial Surgical Research Fund and the 2011 Research Grant of the Toki Fund, Nihon University School of Medicine.


Arch Surg 2011;146:1293-1299.

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