Blood products and liver transplantation: A strategy to balance optimal preparation with effective blood stewardship.
Blood products and liver transplantation: A strategy to balance optimal preparation with effective blood stewardship.
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DOI：
10.1111/trf.17074
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发表时间：
2022-10
期刊：
影响因子：
2.9
通讯作者：
Al-Adra, David P.
中科院分区：
文献类型：
--
作者：
Little, Christopher J.;Leverson, Glen E.;Hammel, Laura L.;Connor, Joseph P.;Al-Adra, David P.
关键词：
肝移植期间意外的输血需求可能会延迟挽救生命的术中复苏并使血库资源紧张。风险分层的术前血液准备可以减轻这些有害结果。回顾性评估了肝移植的双层血液制备方案。十一个二元变量作为高风险（HR）分配的标准。主要结局包括红细胞（RBC）、血浆（FFP）和血小板（Plt）利用率。次要结果包括产品准备不足和过度。使用 15 个临床变量生成高于总体平均值的输血需求的列联表。使用研究人群开发并回顾性优化了修改后的方案。在 225 名接受者中，102 人收到了 HR 术前命令，这与较高的术中输血需求相关。然而，单变量分析仅确定了每种产品的两个统计风险因素：红细胞的 Hgb ≤7.8 g/dl (p < .001) 和 MELD ≥38 (p = .035)，FFP 的 Hgb ≤7.8 g/dl (p = .002) 和急性酒精性肝炎 (p = 0.015)，以及 Hgb Plts ≤7.8 g/dl (p = .001) 和常温肝脏保存 (p = .037)。基于这些发现，我们针对个别产品制定了修改方案，并对其在减少准备不足事件同时限制产品过度准备方面的有效性进行了回顾性评估。使用队列统计来定义每个方案的准备策略。回顾性比较分析证明了修改方案的优越性，将每种产品的准备不足率从 24% 提高到 <10%，这需要 RBC 和 FFP 过度准备分别增加 1.56 倍和 1.44 倍。重要的是，Plt 过度准备没有差异。我们报告了用于肝移植的可翻译数据驱动的血库准备方案。
Unanticipated transfusion requirements during liver transplantation can delay lifesaving intraoperative resuscitation and strain blood bank resources. Risk‐stratified preoperative blood preparation can mitigate these deleterious outcomes. A two‐tiered blood preparation protocol for liver transplantation was retrospectively evaluated. Eleven binary variables served as criteria for high‐risk (HR) allocation. Primary outcomes included red blood cell (RBC), plasma (FFP), and platelet (Plt) utilization. Secondary outcomes included product under‐ and overpreparation. Contingency tables for transfusion requirements above the population means were generated using 15 clinical variables. Modified protocols were developed and retrospectively optimized using the study population. Of 225 recipients, 102 received HR preoperative orders, which correlated to higher intraoperative transfusion requirements. However, univariate analysis identified only two statistical risk factors per product: Hgb ≤7.8 g/dl (p < .001) and MELD ≥38 (p = .035) for RBCs, Hgb ≤7.8 g/dl (p = .002) and acute alcoholic hepatitis (p = 0.015) for FFP, and Hgb ≤7.8 g/dl (p = .001) and normothermic liver preservation (p = .037) for Plts. Based on these findings, we developed modified protocols for individual products, which were evaluated retrospectively for their effectiveness at reducing under‐preparatory events while limiting product overpreparation. Cohort statistics were used to define the preparation strategy for each protocol. Retrospective comparative analysis demonstrated the superiority of the modified protocols by improving the under‐preparation rate from 24% to <10% for each product, which required a 1.56‐fold and 1.44‐fold increase in RBC and FFP overpreparation, respectively. Importantly, there was no difference in Plt overpreparation. We report translatable data‐driven blood bank preparation protocols for liver transplantation.
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