Predictors of blood product use in orthotopic liver transplantation using the piggyback hepatectomy technique
Predictors of blood product use in orthotopic liver transplantation using the piggyback hepatectomy technique
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DOI：
10.1016/j.transproceed.2007.09.029
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发表时间：
2007-12-01
影响因子：
0.9
通讯作者：
Tector, A. J.
中科院分区：
文献类型：
--
作者：
Mangus, R. S.;Kinsella, S. B.;Tector, A. J.
原位肝移植（OLT）历来与大量失血和血流动力学不稳定有关，这与静脉曲张、凝血功能障碍、血小板减少和门静脉高压共存有关。背负式肝切除术（PGB）是OLT中越来越多使用的一种技术，以避免静脉-静脉旁路和腔静脉夹紧。本研究评估了与pgb患者失血和血液制品需求相关的因素。本研究回顾性回顾了42个月来所有成人尸体肝移植手术的麻醉、术前、手术记录和计算机化验室数据。这些数据与肝移植数据库相结合进行分析。大约98%的移植手术采用标准的背驮式入路，不使用静脉-静脉旁路。数据包括在此期间进行的所有526例移植。估计失血量（EBL）为1000毫升。输血需要量中位数为3单位包装红细胞、7单位新鲜冷冻血浆和6单位血小板。多因素线性回归表明，EBL的预测因子为年龄、MELD评分、术前血红蛋白、初始纤维蛋白原、初始中心静脉压和总麻醉时间。PRBC使用的预测因子为年龄、MELD评分、术前血红蛋白、初始纤维蛋白原和麻醉时间。术后输血需求增加与住院时间延长、90天和1年移植和患者生存率降低有关。这些结果表明，PGB可以安全地在几乎所有的肝移植患者中完成，无需静脉-静脉旁路或腔静脉夹紧，并且较少的热缺血，这可能最终减少围手术期发病率和改善预后。
Orthotopic liver transplantation (OLT) has historically been associated with massive blood loss and hemodynamic instability related to the coexistence of varices, coagulopathy, thrombocytopenia, and portal hypertension. Piggyback hepatectomy (PGB) is a technique increasingly utilized in OLT to avoid veno-venous bypass and vena cava clamping. This study evaluated the factors associated with blood loss and blood product requirement in PGB.Methods. This study is a retrospective review of the anesthesia preoperative and operative notes and computerized lab values for all adult cadaveric liver transplants over a 42-month period. These data were combined with the liver transplant database for analysis. Approximately 98% of the transplants were performed using a standard piggyback approach with no use of veno-venous bypass.Results. Data were included for all 526 transplants performed during this time period. Estimated blood loss (EBL) was 1000 cc. Median transfusion requirement was 3 units packed red blood cells, 7 units fresh frozen plasma, and 6 units platelets. Multivariate linear regression demonstrated that predictors of EBL were age, MELD score, preoperative hemoglobin, initial fibrinogen, initial central venous pressure, and total anesthesia time. Predictors of PRBC useage were age, MELD score, preoperative hemoglobin, initial fibrinogen, and anesthesia time. Postoperatively increased transfusion requirement was associated with increased length of hospital stay and lower 90-day and 1-year graft and patient survivals.Conclusion. These results demonstrate that PGB can be safely accomplished in nearly all liver transplant patients without venovenous bypass or vena cava clamping and with less warm ischemia, which may ultimately be associated with less perioperative morbidity and improved outcomes.