Association Between Red Blood Cell Distribution Width and Intraoperative Transfusion in Patients Undergoing Living Donor Liver Transplantation: a Retrospective Single-center Cohort Study

Abstract Background: Living donor liver transplantation (LDLT) has been associated with massive bleeding and increased blood transfusion requirements. However, information on indicators predicting bleeding and transfusion in LDLT is limited. Recent studies have reported a correlation between red cell distribution width (RDW) and bleeding risk. This study investigates the association between RDW and intraoperative blood transfusion in patients receiving LDLT.Methods: This retrospective study analyzed 2548 patients who underwent LDLT between January 2010 and October 2019. The patients were divided into four groups based on preoperative RDW quartiles: Q1 (<13.9), Q2 (13.9–15.2), Q3 (15.2–17.4), and Q4 (≥17.4), and transfusion requirement and surgical outcomes were assessed. The risk factors for intraoperative transfusion were evaluated by multivariate regression analysis. The predictive power of RDW was assessed through receiver operating characteristic (ROC) and integrated discrimination improvement (IDI) analysis.Results: There were significant differences in incidence of intraoperative transfusion according to preoperative RDW quartile (Q1 vs Q2 vs Q3 vs Q4: 47.3% vs. 78.1% vs. 91.8% vs. 96.2%, P<0.001). Q4 had poor surgical outcomes, such as acute kidney injury (adjusted odds ratio [OR]: 1.91, 95% CI: 1.44–2.54, P<0.001). In the multivariate logistic analysis, RDW, age, sex, diabetes mellitus, coronary artery disease, model for end-stage liver disease scores, and total ischemic time were risk factors for transfusion. In ROC and IDI analysis, RDW had predictive power for intraoperative transfusion (P=0.023 in IDI).Conclusions: Preoperative RDW is a potential predictor of intraoperative transfusion and postoperative acute kidney injury in patients receiving LDLT.