Transfusion Rate for 500 Consecutive Liver Transplantations: Experience of One Liver Transplantation Center
Transfusion Rate for 500 Consecutive Liver Transplantations: Experience of One Liver Transplantation Center
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DOI：
10.1097/tp.0b013e318250fc25
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发表时间：
2012-06-27
期刊：
影响因子：
6.2
通讯作者：
Roy, Andre
中科院分区：
文献类型：
--
作者：
Massicotte, Luc;Denault, Andre Y.;Roy, Andre
背景。原位肝移植（OLT）与大量失血和需要输血有关。在过去十年中，手术和麻醉管理的改进减少了术中出血量和血液制品输血。我们小组2005年发表的第一份报告描述了连续61次OLTs的平均术中输血率为每位患者0.3个红细胞（RBC）单位。在这些患者中，80.3%没有接受任何血液制品。导致这些结果的干预措施是限制液体、静脉切开术、自由使用血管加压药物和避免预先输入新鲜冷冻血浆的组合。这是一项随访观察性研究，涵盖了500个连续的olts方法。研究了500个连续的olt。将前61例OLTs与后439例OLTs的输血率进行比较。此外，采用多因素logistic回归确定术中输血的主要预测因素。在500例OLTs中，每位患者平均输血0.5（1.3）个RBC单位，其中79.6%未接受任何血液制品。除了最后439例OLTs的最终血红蛋白（Hb）值高于先前报道的小型研究（94 [20]g/L vs 87 [20] g/L）外，组间没有差异。两个变量，起始Hb值和静脉切开术，与不输血的OLT相关。在我们中心，术中低输血率可以在500个连续的olt中保持。出血与受者疾病的严重程度无关。在不输血的情况下，起始Hb值与OLT的相关性最强。
Background. Orthotopic liver transplantation (OLT) has been associated with major blood loss and the need for blood product transfusions. During the last decade, improved surgical and anesthetic management has reduced intraoperative blood loss and blood product transfusions. A first report from our group published in 2005 described a mean intraoperative transfusion rate of 0.3 red blood cell (RBC) unit per patient for 61 consecutive OLTs. Of these patients, 80.3% did not receive any blood product. The interventions leading to those results were a combination of fluid restriction, phlebotomy, liberal use of vasopressor medications, and avoidance of preemptive transfusions of fresh frozen plasma. This is a follow-up observational study, covering 500 consecutive OLTs.Methods. Five hundred consecutive OLTs were studied. The transfusion rate of the first 61 OLTs was compared with the last 439 OLTs. Furthermore, multivariate logistic regression was used to determine the main predictors of intraoperative blood transfusion.Results. A mean (SD) of 0.5 (1.3) RBC unit was transfused per patient for the 500 OLTs, and 79.6% of them did not receive any blood product. There was no intergroup difference except for the final hemoglobin (Hb) value, which was higher for the last 439 OLTs compared with the previously reported smaller study (94 [20] vs. 87 [20] g/L). Two variables, starting Hb value and phlebotomy, correlated with OLT without transfusion.Conclusions. In our center, a low intraoperative transfusion rate could be maintained throughout 500 consecutive OLTs. Bleeding did not correlate with the severity of recipient's disease. The starting Hb value showed the strongest correlation with OLT without RBC transfusion.