Plasma transfusion in liver transplantation: a randomized, double-blind, multicenter clinical comparison of three virally secured plasmas.
Bartelmaos T, Chabanel A, et al.Transfusion [record in progress].
Aims
To compare the clinical efficacy of three fresh frozen plasmas (FFP) in liver transplant recipients.
Interventions
Quarantine-stored plasma (Q-FFP) versus solvent/detergent–treated plasma (S/D-FFP) versus methylene blue–treated plasma (MB-FFP). A minimal FFP dose of 15 mL/kg was recommended.
Participants
293 liver transplant recipients requiring FFP transfusion.
Outcomes
The primary outcome was the total volume of plasma transfused in the operating room during liver transplantation. Secondary outcomes were blood loss during the full surgical intervention, the extent of correction of laboratory coagulation variables, and all adverse events. Plasma volume transfused during the first transfusion episode was also analysed.
Follow-up
Surgical intervention period
CET Conclusions
This is a very good quality study of the efficacy of three types of fresh-frozen plasma in liver transplantation. As of 2005, fresh-frozen plasma, which is often needed in liver transplantation to cover coagulation defects, was prepared in 3 ways to secure the product from viral contamination. Quarantined stored plasma (Q-FFP), solvent/detergent-treated plasma (S/D-FFP) and methylene blue treated plasma (MB-FFP) in vitro have different effects on the coagulation pathway, and in this large double blind randomised trial the clinical efficacy of the 3 types of therapeutic plasma was not equivalent. In fact the total volume of plasma transfused in the operating room during the liver transplant procedure, which was the primary outcome, differed between the three types of plasma used. In particular the MB- FFP required a greater volume to be transfused compared to Q- FFP or S/D - FFP.
Data analysis
Strict intention-to-treat analysis
Trial registration
ClinicalTrials.gov - NCT00235183