Incidence and clinical significance of hyperfibrinolysis during living donor liver transplantation
Incidence and clinical significance of hyperfibrinolysis during living donor liver transplantation
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DOI：
10.1097/mbc.0000000000000733
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发表时间：
2018-04-01
影响因子：
1.1
通讯作者：
Kim, Gaab-Soo
中科院分区：
文献类型：
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作者：
Kim, Eun-Hee;Ko, Justin S.;Kim, Gaab-Soo
我们采用粘弹性凝血试验评价活体肝移植（LDLT）术中纤溶亢进的发生率和临床意义。我们回顾性分析了2010年2月至2015年2月的成人LDLT接受者。当凝块溶解指数[LY 60 =（MA-A（60））/MAx 100，%]小于85时定义为纤溶亢进，其中A（60）为最大振幅（MA）出现后60 min的凝块振幅。分别于麻醉诱导后即刻、无肝前期结束、无肝期后1h、再灌注后5 min、再灌注后1h、再灌注后3 h进行6次粘弹性凝血试验。最终分析纳入了110例受试者。纤溶亢进在无肝前期不常见（T1为0%，T2为4.5%），在无肝期加重，再灌注后立即达到峰值，T3为18%，T4为71%。然而，纤溶亢进在再灌注后1小时几乎消失，并且没有复发; T5时为0.9%，T6时为0%。纤维蛋白溶解亢进不能从术前人口统计学和凝血特征预测。然而，纤溶亢进组的凝血功能紊乱和术中失血量更大。LDLT过程中，高纤溶常发生在无肝期和再灌注后即刻，但在再灌注后阶段消退。
We evaluated the incidence and clinical significance of hyperfibrinolysis during living donor liver transplantation (LDLT) using viscoelastic coagulation tests. We retrospectively reviewed adult LDLT recipients from February 2010 to February 2015. Hyperfibrinolysis was defined when clot lysis index [LY60=(MA-A(60))/MAx100, %] was less than 85, where A(60) is the clot amplitude at 60min after maximum amplitude (MA) occurred. Viscoelastic coagulation tests were performed six times (T1: immediately after anesthetic induction, T2: end of preanhepatic phase, T3: 1h after anhepatic phase, T4: 5min after reperfusion, T5: 1h after reperfusion, and T6: 3h after reperfusion). One hundred-ten recipients were included in final analysis. Hyperfibrinolysis was uncommon in preanhepatic phase (0% at T1 and 4.5% at T2) and aggravated during anhepatic phase and peaked immediately after reperfusion, 18% at T3 and 71% at T4. However, hyperfibrinolysis nearly disappeared 1h after reperfusion and did not recur; 0.9% at T5 and 0% at T6. Hyperfibrinolysis was not predicted from preoperative demographics and coagulation profiles. However, the degree of coagulation profile derangements and intraoperative blood loss was greater in the hyperfibrinolysis group. During LDLT, hyperfibrionlysis frequently occurred at anhepatic phase and immediately after reperfusion, but it was resolved during postreperfusion phase.