ESPU Congress 2017 - Abstract book

CONGRESS OF THE ESPU

10:02–10:05

S6-7 (PP)

BLOOD PRODUCT UTILIZATION PATTERN IN PEDIATRIC

RENAL TRANSPLANTATION: A SINGLE INSTITUTION

ANALYSIS

Frank PENNA

, Rakan ODEH

, Teresa SKELTON

, Naimet NAOUM

Armando LORENZO

, Walid FARHAT

and Martin KOYLE

1) Dartmouth | Geisel School of Medicine, Children’s Hospital at Dartmouth, Pediatric Urology, Hanover, USA -

2) The Hospital for Sick Children, Division of Paediatric Urology, Toronto, CANADA - 3) The Hospital for Sick Children,

Department of Paediatric Anesthesia, Toronto, CANADA

INTRODUCTION

In renal transplantation (RT), there is an inherent lack of evidence-based guidelines to guide the

amount and need of cross-matching blood products for surgery. Due to the inherent added costs,

limited availability of blood products and potential waste if not used, we aimed to evaluate our

practice to identify factors that can lead to standardized policy for blood product utilization in RT.

PATIENTS AND METHODS

Retrospective chart review of patients who underwent pediatric RT over a 10-year period at our

institution was performed. Variables analyzed included: patient age, weight, pre- and post-operative

hemoglobin (Hb), donor source (deceased- or living-donor), estimated allograft size by ultrasound,

mean intra-operative blood loss (EBL), erythropoietin, number of units transfused per case, cross-

matched/transfusion (C:T) ratio, overall transfusion rate, type of dialysis and the total cost of unused

cross matched units.

RESULTS

RT was performed in 188 patients during the study period. Males represented 59.5% (n=112) and

females, 40.5% (n=76). Of these, 54% (103/188) received blood transfusions. The total number

of units cross-matched was 455 (2.3 units/patient). Average EBL was 212 mL, and C:T ratio was

2.6:1. Univariate analysis of factors predictive of the need for intra-operative blood transfusion

demonstrated the following statistically significant parameters: pre-operative Hb, age, weight, and

EBL. Multivariate analysis showed EBL as the only factor predictive of the need for intra-operative

blood transfusion. Total estimated cost of unused cross-matched units was $22,282.

CONCLUSIONS

At our center, the number of unused cross matched units in pediatric renal transplantation repre-

sents a considerable waste of limited resources. EBL is the only factor predictive of intra-operative

transfusion. More efficient institutional policies with regard to blood cross-matching in RT are

in-progress.

10:05–10:20

Discussion