The impact of intraoperative transfusion of platelets and red blood cells on survival after liver transplantation
The impact of intraoperative transfusion of platelets and red blood cells on survival after liver transplantation
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DOI：
10.1213/01.ane.0000289638.26666.ed
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发表时间：
2008-01-01
影响因子：
5.7
通讯作者：
Porte, Robert J.
中科院分区：
文献类型：
--
作者：
de Boer, Marieke T.;Christensen, Michael C.;Porte, Robert J.
背景：术中输注红细胞（RBC）与原位肝移植（OLT）后的不良结果相关。尽管实验研究表明血小板会导致肝脏再灌注损伤，但同种异体血小板输注对结果的影响尚未得到详细研究。在这项研究中，我们评估了各种血液制品对 OLT 后结局的影响。方法：对 1989 年至 2004 年间 433 名接受第一次 OLT 的成年患者的 29 个变量（包括血液制品输注）进行了研究。使用单变量和多变量逐步 Cox 比例风险分析以及血小板输注的倾向评分调整分析来控制血液使用中的选择偏倚来分析数据。结果：接受任何血液成分输血的患者比例从 1989-1996 年期间的 100% 下降到 1997-2004 年期间的 74%。在单变量和多变量分析中，移植指征、血小板输注和红细胞在预测患者一年生存率方面占主导地位。这些危险因素独立于公认的疾病指数，例如终末期肝病模型评分和卡诺夫斯基评分。对 1 年生存率的影响与剂量相关，每单位血小板的风险比为 1.377（P = 0.01），每单位红细胞的风险比为 1.057（P = 0.001）。倾向调整分析证实了血小板输注对生存的负面影响。结论：这项回顾性研究表明，除了红细胞之外，血小板输注是OLT后生存的独立危险因素。这些发现对肝移植受者的输血实践具有重要意义。
BACKGROUND: Intraoperative transfusion of red blood cells (RBC) is associated with adverse outcome after orthotopic liver transplantation (OLT). Although experimental studies have shown that platelets contribute to reperfusion injury of the liver, the influence of allogeneic platelet transfusion on outcome has not been studied in detail. In this study, we evaluate the impact of various blood products on outcome after OLT.METHODS: Twenty-nine variables, including blood product transfusions, were studied in relation to outcome in 433 adult patients undergoing a first OLT between 1989 and 2004. Data were analyzed using uni- and multivariate stepwise Cox's proportional hazards analyses, as well as propensity score-adjusted analyses for platelet transfusion to control for selection bias in the use of blood products.RESULTS: The proportion of patients receiving transfusion of any blood component decreased from 100% in the period 1989-1996 to 74% in the period 1997-2004. In uni- and multivariate analyses, the indication for transplantation, transfusion of platelets and RBC were highly dominant in predicting 1-yr patient survival. These risk factors were independent from well-accepted indices of disease, such as the Model for End-Stage Liver Disease score and Karnofsky score. The effect on 1-yr survival was dose-related with a hazard ratio of 1.377 per unit of platelets (P = 0.01) and 1.057 per unit of RBC (P = 0.001). The negative impact of platelet transfusion on survival was confirmed by propensity-adjusted analysis.CONCLUSION: This retrospective study indicates that, in addition to RBC, platelet transfusions are an independent risk factor for survival after OLT. These findings have important implications for transfusion practice in liver transplant recipients.