Intraoperative Fresh Frozen Plasma-to-Red Blood Cell Ratio and Postoperative Pulmonary Infection in Adult Liver Transplantation: A Retrospective Cohort Study

Abstract Introduction: The clinical relevance of the intraoperative fresh frozen plasma (FFP)-to-red blood cell (RBC) transfusion ratio during adult liver transplantation (LT) is uncertain. We evaluated its association with postoperative pulmonary infection and 365-day mortality.

Methods

We retrospectively analyzed adults undergoing first LT from January 2021 through December 2023 who received at least 1 U of intraoperative RBC. Patients were grouped by FFP:RBC ratio (≤1 vs. >1). Pulmonary infection was obtained from the pre-existing transplant registry; child-field -1 codes were decoded using the parent early-complication field, with manual reconciliation of the sole discordant record. Logistic regression was adjusted for MELD score and blood loss. Mortality was analyzed with Kaplan-Meier and Cox methods.