(P-PB-9) Blood Utilization in Liver Transplant Patients Transfused with non-Pathogen Reduced vs Pathogen Reduced Platelets

Background/Case Studies: FDA standards to reduce the risk of septic transfusion reactions require either bacterial culture or pathogen inactivation of Platelets (PLT). The only pathogen reduction system approved by the US FDA utilizes ultraviolet light activated amotosalen which covalently binds to DNA/RNA, preventing replication. Previous studies show a slight decrement to platelet function thought to be clinically insignificant in studied populations. Pathogen reduced (PR) platelets have not been compared to nonPR in adult liver transplant patients with active bleeding.

Study

Design/Methods: From January 2017-March 2022 at our institution, a dual inventory of PR and non-PR platelets were transfused to adults based on random availability and expiration dates. Liver transplant patients were transfused intraoperatively based on surgeon assessment of coagulopathy and thromboelastography (TEG). Patients who received PR-only platelets, non-PR-only platelets, or a mixed inventory were grouped and retrospectively analyzed regarding preoperative, intraoperative, and postoperative transfusion burden, as well as demographics. Statistical analysis was performed using SAS software v9.4.

Results/Findings: 137 patients received PR-only platelets, 110 patients received non-PR-only platelets (see Table 1), and 32 patients received a mixed inventory. For all patients, the probability of receiving an additional platelet transfusion was higher if the first unit was PR (54.01%) versus if the unit was non-PR (43.18%). Furthermore, increased mortality was observed in the PR-only group compared to the non-PR-only group (7 vs 0 patients).

Conclusions: PR platelets are associated with slightly higher rates of intraoperative and post-operative blood component usage as analyzed by both total transfusions and probability of receiving additional intraoperative transfusions in liver transplant patients. We believe additional prospective controlled and randomized trials are warranted to further investigate the observed impact of PR-only platelets on increased blood component usage as well as to characterize the function of PR platelets for active bleeding and wound healing.

Importance of research: While it is known that a transition to PR Platelets from non-PR platelets results in a slight increase in utilization in studied populations, there is no data evaluating this impact on liver transplant procedures. This study is the first to perform this evaluation and will assist administrators and clinicians in assessing the financial and possible clinical impact of the transition. Further studies are warranted before assuming no significant inferiority of PR platelets in this population.