Validating the McCluskey Index for the Necessity for Hemoderivative Transfusion in our Liver Transplant Serie
Iago Justo 1, Pilar Del Pozo1, oscar Caso1, Isabel Lechuga1, María García-Conde1, Anisa Nutu1, Alberto Marcacuzco1, Laura Alonso1, Felix Cambra1, Alvaro García-Sesma1, Jorge Calvo1, Alejandro Manrique1, Carlos Jimenez-Romero1.
1General Surgery, "12 de Octubre" U. H., Madrid, Spain
Introduction: The haemorrhage during the liver transplantation (LT) is associated with high morbimortality rates and lower graft survival, thus its prevention is fundamental in LT. The McCluskey index has been used as a tool for the prediction of massive bleeding (>6 RBC units). The objective of this study is to verify its efficacy in our patients.
Materials and Methods: Between May 1998 and December 2015, we performed 1216 LT, of which data with respect to hemoderivative transfusion could be recorded in 1016 patients. We divided the patients into groups with respect to the original study of the McCluskey serie: Low Risk (LR 0 Point) 5 patients; Medium Risk (MR 1-2 points) 471 patients; High Risk (HR 3-5) 520 patients and very high risk (VHR 6 points) 20 patients.
Results: The mean recipient age in the 3 groups was: 31.8±7 years for LR; 53.7±11.2 for MR; 53.8 ±10 for HR and 55.4± 8 (p=0,000). The mean MELD score was 10±2 for LR; 12.7±4 for MR and 18.2±6 for HR (p=0,000). The percentage of HCV patients was 20% for HR, 43.2% for MR, 46.7% for HR and 45% in VHR (p=0,478), whereas that of patients with hepatocarcinoma was: 0% for LR; 37.9% for MR, 20.7% for HR, and 15% for VHR (p=0,000). No significant differences were observed with respect to BMI, hospital stay, neither ICU stay. No different has been found in suboptimal donors among the groups.
With respect to hemoderivatives transfusion between the 3 groups we observed what follows:
Transfusion of red blood cells: 5±2.5 units for LR; 8±10 for MR; 11±13 for HR and 15.8±10 for VHR(p=0.000).
Transfusion of plasma: 11±4.6 units for LR; 13±10 for MR; 16±12 for HR and 15.6±9 for VHR(p=0,001).
Transfusion of platelets: 0±0 units for LR; 2.7±4 for MR; 3.9±3 for HR and 3.5±3 for VHR (p=0,000).
Transfusion of fibrinogen (in grams): 0±0 for LR; 0.98±2 for MR and 1.6±2.6 for HR and 2.9± 3 for VHR (p=0,000).
Conclusion: The McCluskey index is a good indicator of the risk of haemorrhage, and hence, for the necessity of transfusion. The clinical utility of this index would be more practical if the groups could be divided into more groups, to have a more specific index.
