Minimizing blood loss in liver transplantation: Progress through research and evolution of techniques
Minimizing blood loss in liver transplantation: Progress through research and evolution of techniques
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DOI：
10.1159/000088056
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发表时间：
2005-01-01
影响因子：
2.7
通讯作者：
Porte, RJ
中科院分区：
文献类型：
--
作者：
de Boer, MT;Molenaar, IQ;Porte, RJ
长期以来，肝移植过程中的失血一直被认为是发病的一个重要原因，尤其是在早期，也是死亡率的一个重要原因。众所周知，输血会增加术后并发症的风险，例如感染、肺部并发症、恢复时间延长和再次手术率较高。过去几十年进行了许多研究来阐明肝移植中失血增加的机制。 20世纪80年代末，原发性纤溶亢进被认为是肝移植过程中出血的重要机制。这为肝移植受者使用抗纤溶药物提供了科学依据。几项随机对照研究表明这些化合物在减少肝移植过程中失血和输血需求方面的功效。此外，随着手术技术、麻醉护理和更好的移植物保存方法的经验不断增加和改进，大多数肝移植项目的输血需求稳步减少。目前，一些中心报告称，高达 30% 的患者无需输血即可进行肝移植。尽管取得了这些进步，大多数接受肝移植的患者仍然需要输血，这会对结果产生负面影响，这强调了外科医生和麻醉师需要进一步尝试控制失血。本文概述了过去二十年中临床和研究进展，这些进展有助于减少失血量和输血需求，从而显着降低肝移植后的发病率和死亡率。
Blood loss during liver transplantation has long been recognized as an important cause of morbidity and, especially in the early days, also mortality. It is well known that blood transfusions are associated with an increased risk of postoperative complications, such as infections, pulmonary complications, protracted recovery, and a higher rate of reoperations. Many studies have been performed during the past decades to elucidate the mechanisms of increased blood loss in liver transplantation. In the late 1980s, primary hyperfibrinolysis was identified as an important mechanism of bleeding during liver transplantation. This has provided the scientific basis for the use of antifibrinolytic drugs in liver transplant recipients. Several randomized, controlled studies have shown the efficacy of these compounds in reducing blood loss and transfusion requirements during liver transplantation. In addition, increasing experience and improvements in surgical technique, anesthesiological care and better graft preservation methods have contributed to a steady decrease in blood transfusion requirements in most liver transplant programs. Several centers are now reporting liver transplantation without any need for blood transfusion in up to 30% of their patients. Despite these improvements, most patients undergoing liver transplantation still require blood transfusions that have a negative impact on outcome, emphasizing the need for further attempts to control blood loss by surgeons and anesthesiologists. This paper provides an overview of the clinical and research developments, which have contributed to a reduction in blood loss and transfusion requirements, resulting in an important reduction in morbidity and mortality after liver transplantation during the last two decades.