The impact of postreperfusion syndrome on short-term patient and liver allograft outcome in patients undergoing orthotopic liver transplantation
The impact of postreperfusion syndrome on short-term patient and liver allograft outcome in patients undergoing orthotopic liver transplantation
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DOI：
10.1002/lt.21381
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发表时间：
2008-04-01
影响因子：
4.6
通讯作者：
Marcos, Amadeo
中科院分区：
文献类型：
--
作者：
Hilmi, Ibtesam;Horton, Charles N.;Marcos, Amadeo
肝移植损伤的最大部分发生在再灌注期间，而不是在冷缺血阶段。因此，本研究的目的是研究再灌注后综合征（PRS）的严重程度如何影响患者和肝脏移植物的短期结果。本回顾性研究共纳入338例连续2年的原位肝移植患者，根据患者发生PRS的严重程度分为2组。第一组包括152例轻度或无PRS的患者;第二组包括186例显著PRS的患者。收集并分析两组的围手术期血流动力学参数、凝血特征、血液制品需求、感染发生率、排斥发生率和结局数据。除年龄外，两组之间无人口统计学差异;第2组患者年龄大于第1组（54.94 +/- 9.07 vs 51.52 +/- 9.91，P = 0.001）。与组1相比，组2患者需要更多的红细胞输注（11.31 +/- 10.90 vs 8.08 +/- 7.89单位，P = 0.002），更多新鲜冷冻血浆输注（10.25 +/- 10.96 vs 7.03 +/- 7.64单位，P = 0.002）更多冷沉淀（1.88 +/- 4.72单位对0.61 +/- 1.80单位，P = 0.001），更可能发生纤维蛋白溶解（52.7%对41.4%，P = 0.041）。有趣的是，第2组的平均热缺血时间比第1组短（33.19 +/- 8.55 vs 36.21 +/- 11.83分钟，P = 0.01）。第2组平均需要更长时间的机械通气（14.95 +/- 29.79 vs 8.55 +/- 17.79天，P = 0.015），在重症监护室停留时间更长（17.65 +/- 31.00 vs 11.49 +/- 18.67天，P = 0.025），住院时间更长（27.29 +/- 32.35 vs 20.85 +/- 21.08天，P = 0.029）。第2组更可能需要再次移植（8.6% vs 3.3%，P = 0.044）。总之，奥尔特期间PRS的严重程度似乎与患者和肝移植物的结局有关。
The greatest part of liver allograft injury occurs during reperfusion, not during the cold ischemia phase. The aim of this study, therefore, was to investigate how the severity of postreperfusion syndrome (PRS) influences short-term outcome for the patient and for the liver allograft. Over a 2-year period, 338 consecutive patients who presented for orthotopic liver transplantation (OLT) were included in this retrospective study, They were divided into 2 groups according to the severity of the PRS they experienced. The first group comprised 152 patients with mild or no PRS; the second group comprised 186 patients with significant PRS. Perioperative hemodynamic parameters, coagulation profiles, blood product requirements, incidence of infection, incidence of rejection and outcome data for both groups were collected and analyzed. There was no demographic difference between the groups except for age; group 2 had older patients than group 1 (54.94 +/- 9.07 versus 51.52 +/- 9.91, P = 0.001). Compared to group 1, group 2 patients required more red blood cell transfusions (11.31 +/- 10.90 versus 8.08 +/- 7.89 units, P = 0.002), more fresh frozen plasma transfusions (10.25 +/- 10.96 versus 7.03 +/- 7.64 units, P = 0.002) more cryoprecipitate (1.88 +/- 4.72 units versus 0.61 +/- 1.80 units, P = 0.001), and were more likely to suffer from fibrinolysis 52.7% versus 41.4%, P = 0.041). Interestingly, group 2 had a shorter average warm ischemia time than group 1 (33.19 +/- 8.55 versus 36.21 +/- 11.83 minutes, P = 0.01). Group 2 also required longer, on average, mechanical ventilation (14.95 +/- 29.79 versus 8.55 +/- 17.79 days, P = 0.015), remained in the intensive care unit longer (17.65 +/- 31.00 versus 11.49 +/- 18.67 days, P = 0.025), and had a longer hospital stay (27.29 +/- 32.35 versus 20.85 +/- 21.08 days, P = 0.029). Group 2 was more likely to require retransplantation (8.6% versus 3.3%, P = 0.044). In conclusion, the severity of PRS during OLT appears to be related to the outcome of patient and liver allograft.