Postoperative coagulation profiles of patients undergoing adult-to-adult living donor liver transplantation?A single-center experience
Postoperative coagulation profiles of patients undergoing adult-to-adult living donor liver transplantation?A single-center experience
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成人对成人活体肝移植患者的术后凝血特征？单中心经验
DOI：
10.1016/j.tpr.2019.100037
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发表时间：
2020
影响因子：
--
通讯作者：
Hara Tetsuya
中科院分区：
文献类型：
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作者：
Ichinomiya Taiga;Murata Hiroaki;Sekino Motohiro;Sato Shuntaro;Higashijima Ushio;Matsumoto Shuhei;Ishizaki Hironori;Yoshitomi Osamu;Maekawa Takuji;Eguchi Susumu;Hara Tetsuya
目的利用各种凝血测试和旋转血栓弹力测定法 (ROTEM) 来表征接受成人对成人活体肝移植 (LDLT) 的患者术前和术后的凝血特征。 方法这项单中心观察性研究评估了 22 名患者（13 名男性和 9 名女性）的各种凝血特征。麻醉诱导后 (PRE) 以及 LDLT 手术后第 1、3、5 和 7 天 (POD) 立即采集血样。结果 大多数促凝血因子（纤维蛋白原、血小板和凝血因子 II、VII、VIII 和 IX）在 POD 7 时改善至等于或高于 PRE 水平。术后 von Willebrand 因子水平显着升高 手术后，解整合素样酶和具有血小板反应蛋白 1 型基序 13 的金属蛋白酶的酶降低。虽然凝血酶-抗凝血酶 III 复合物在手术后立即增加，但纤溶酶-α 2 纤溶酶抑制剂复合物仅在 POD 7 时增加。纤溶酶原激活物抑制剂-1 的水平在 POD 1 上增加，在 POD 3 上恢复到 PRE 水平。与 PRE 水平相比，几乎所有 ROTEM 参数在 POD 7 上均降低或延长。结论 大多数凝血测试的值显示出改善或加速 POD 7 的凝血能力高于 PRE，几乎所有 ROTEM 参数均降低或延长。因此，无法断定ROTEM是否反映了肝移植术后止血平衡的净效应。
ObjectiveTo characterize the pre- and postoperative coagulation profiles of patients undergoing adult-to-adult living donor liver transplantation (LDLT), using various coagulation tests and rotational thromboelastometry (ROTEM).MethodsThis single-center observational study evaluated the various coagulation profiles of 22 patients (13 men and 9 women). Blood samples were obtained immediately after the induction of anesthesia (PRE) and on postoperative days (PODs) 1, 3, 5, and 7 after LDLT surgery.ResultsMost procoagulant factors (fibrinogen, platelet, and coagulation factors II, VII, VIII, and IX) improved to levels equal to or greater than the PRE levels on POD 7. The levels of von Willebrand factor significantly increased after surgery, whereas those of disintegrin-like and metalloproteinase with thrombospondin type 1 motif 13 decreased. Although the thrombin-antithrombin III complex increased immediately after surgery, the plasmin-α 2 plasmin inhibitor complex increased only on POD 7. The level of plasminogen activator inhibitor-1 increased on POD 1, returning to PRE levels on POD 3. Almost all ROTEM parameters were decreased or prolonged, compared to the PRE levels, on POD 7.ConclusionsThe values of most coagulation tests showed the improvement or acceleration of coagulability on POD 7 than at PRE, with almost all the ROTEM parameters decreased or prolonged. Therefore, it cannot be concluded whether ROTEM reflects the net effect of hemostatic balance after liver transplantation.