Liver transplantation is associated with significant blood loss, often requiring massive blood product transfusion.
Transfusion-related acute lung injury (
TRALI) is a devastating cause of transfusion-related deaths. While reports have investigated the general incidence of
TRALI, the incidence of
TRALI specifically following transfusion during
liver transplant remains unclear. This scoping review summarizes existing literature regarding
TRALI during the
liver transplantation perioperative period. Databases were searched for all articles and abstracts reporting on
TRALI after
liver transplantation. Data collected included number of patients studied, patient characteristics, incidences of
TRALI,
TRALI characteristics, and patient outcomes. The primary outcome investigated was the incidence of
TRALI in the setting of
liver transplantation. Thirteen full-text citations were included in this review. The incidence of
TRALI post-
liver transplant was 0.68% (65 of 9,554). Based on reported transfusion data, patients diagnosed with
TRALI received an average of 10.92 ± 10.81 units of packed red blood cells (pRBC), 20.05 ± 15.72 units of fresh frozen plasma, and 5.75 ± 10.00 units of platelets. Common interventions following
TRALI diagnosis included
mechanical ventilation with
positive end-expiratory pressure, inhaled high-flow
oxygen, inhaled pulmonary
vasodilator, and pharmacologic treatment using pressors or inotropes,
corticosteroids, or
diuretics. Based on reported mortality data, 26.67% of patients (12 of 45) diagnosed with
TRALI died during the postoperative period. This scoping review underscores the importance of better understanding the incidence and presentation of
TRALI after
liver transplant surgery. The clinical implications of these results warrant the development of identification and management strategies for
liver transplant patients at increased risk for developing
TRALI.