Preoperative Thromboelastography as a Sensitive Tool Predicting Those at Risk of Developing Early Hepatic Artery Thrombosis After Adult Liver Transplantation
Preoperative Thromboelastography as a Sensitive Tool Predicting Those at Risk of Developing Early Hepatic Artery Thrombosis After Adult Liver Transplantation
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DOI：
10.1097/tp.0000000000001395
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发表时间：
2016-11-01
期刊：
影响因子：
6.2
通讯作者：
Perera, M. Thamara P. R.
中科院分区：
文献类型：
--
作者：
Eldeen, Firas Zahr;Roll, Garrett R.;Perera, M. Thamara P. R.
背景虽然肝移植术后肝动脉血栓形成（HAT）的原因是多因素的，但早期HAT（E-HAT）仍然是影响移植物和患者生存的相关并发症。目前还没有筛查工具可以识别出患有E-HAT风险增加的患者。方法.我们通过移植前血栓弹力图（TEG）数据和其他已知的危险因素分析了LT受者的天然促凝状态，以确定E-HAT的危险因素。结果分析了2008年至2013年期间接受LT的828例成人患者的结局。总体而言，79例（9.5%）患者发生HAT，23例诊断为E-HAT，其余患者为“晚期”HAT。诊断为E-HAT的患者术前TEG的最大振幅（MA）显著高于未诊断为E-HAT的患者（71.2 mm vs 57.9 mm; P < 0.0001）。接受者工作特征分析以65 mm或更大的MA为界值，曲线下面积为0.750（P < 0.001），预测E-HAT的灵敏度为70%。MA ≥ 65 mm的患者中，共有7%的患者发生E-HAT（风险比，5.28; 95%置信区间，2.10-12.29; P < 0.001），而MA <65 mm的患者中，只有1.2%发生E-HAT。结论.术前TEG可以可靠地识别发生E-HAT风险更高的受者组，加强监测和抗凝预防可以避免LT后这种严重的并发症。
Background. Whilst causes of hepatic artery thrombosis (HAT) after liver transplantation (LT) are multifactorial, early HAT (E-HAT) remains pertinent complication impacting on graft and patient survival. Currently there is no screening tool that would identify patients with increased risk of developing E-HAT. Methods. We analyzed the native procoagulant state of LT recipients, identified through pretransplant thromboelastographic (TEG) data among other known risk factors, to identify risk factors for E-HAT. Results. The outcomes of 828 adult patients undergoing LT between 2008 and 2013 were analyzed. Overall, 79 (9.5%) patients experienced HAT, E-HAT was diagnosed in 23, and in the remainder this was "late" HAT. The maximum amplitude (MA) on preoperative TEG was significantly higher in patients diagnosed with E-HAT compared with those who did not (71.2 mm vs 57.9 mm; P < 0.0001). Receiver operating characteristic analysis with the cutoff value for MA of 65 mm or greater returned area under the curve of 0.750 (P < 0.001) predicting E-HAT with a sensitivity of 70%. A total of 7% of patients with an MA of 65 mm or greater went on to develop E-HAT (hazard ratio, 5.28; 95% confidence interval, 2.10-12.29; P < 0.001), whereas only 1.2% patients with an MA less than 65 mm experienced E-HAT. Conclusions. Preoperative TEG may reliably identify group of recipients at greater risk of developing E-HAT, and intense surveillance and anticoagulation prophylaxis may avoid this serious complication after LT.