The effects of intraoperative cryoprecipitate transfusion on acute renal failure following orthotropic liver transplantation.
The effects of intraoperative cryoprecipitate transfusion on acute renal failure following orthotropic liver transplantation.
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术中冷沉淀输注对正交异性肝移植术后急性肾功能衰竭的影响
DOI：
10.1007/s12072-013-9457-9
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发表时间：
2013-07
影响因子：
6.6
通讯作者：
Sun X
中科院分区：
文献类型：
--
作者：
Liu S;Wang X;Lu Y;Li T;Gong Z;Sheng T;Hu B;Peng Z;Sun X
目的关于同种异体肝移植(OLT)后急性肾功能衰竭(ARF)相关危险因素的定义仍存在争议。冷沉淀物可提供纤维蛋白原等凝血因子，在原位肝移植中应用广泛。然而，术中冷沉淀物输注对肝移植后ARF的影响尚不清楚。方法对389例首次行原位肝移植的成人患者，在调整潜在的混杂因素后，对术中冷沉淀物输注与肝移植后ARF的临床相关性进行了回顾性研究。结果输注冷沉淀物的患者急性肾功能衰竭的发生率显著高于未输注冷沉淀物的患者(15.9vs.7.8%，P=0.012)。术中冷沉淀物输注与移植后ARF之间存在非线性关系。随着冷沉淀物输注水平达到转折点(16U)，急性肾功能衰竭的风险增加(调整后的OR1.1，95%可信区间1.1-1.2；P<；0.001)。当冷沉淀物水平超过16U时，输注冷沉淀物水平与急性肾功能衰竭的风险无关(OR0.95，95%可信区间0.85~1.1；P=0.319)。术中输注冷沉淀物的患者术后1年内死亡发生率较高(22.9vs.14.2%，P=0.029)。结论术中输注冷沉淀物与原位肝移植术后急性肾功能衰竭有关。在原位肝移植期间应仔细进行冷沉淀输注，直到找到更有说服力的证据为止。
PurposeThe definition of risk factors associated with acute renal failure (ARF) following orthotropic liver transplantation (OLT) is still controversial. Cryoprecipitate, which can supply fibrinogen and other coagulation factors, is widely used in OLT. However, the effects of intraoperative cryoprecipitate transfusion on ARF following OLT remain unclear.MethodsIn a series of 389 adult patients who received grafts from deceased donors and underwent their first OLT, the clinical correlation between intraoperative cryoprecipitate transfusion and ARF following OLT was retrospectively studied after adjusting for potential confounders. The distribution of ARF and the causes of death within the first year after OLT were also compared separately in patients with and without cryoprecipitate transfusion.ResultsThe incidence of ARF in patients with cryoprecipitate transfusion was significantly higher than in patients without cryoprecipitate transfusion (15.9 vs. 7.8 %,p= 0.012). A nonlinear relationship between intraoperative cryoprecipitate transfusion and ARF following OLT was observed. The risk of ARF increased with the cryoprecipitate transfusion level up to the turning point (16 U) (adjusted OR 1.1, 95 % CI 1.1–1.2;p< 0.001). When the cryoprecipitate level exceeded 16 U, the level of cryoprecipitate transfusion was not associated with the risk of ARF (OR 0.95, 95 % CI 0.85–1.1;p= 0.319). Deaths within the first year after the operation occurred more frequently in cases with cryoprecipitate transfusion (22.9 vs. 14.2 %,p= 0.029).ConclusionsThese findings suggested that intraoperative cryoprecipitate transfusion is associated with ARF following OLT. Cryoprecipitate transfusion during OLT should be performed carefully until more convincing evidence has been found.
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影响因子：
19.6
作者：
Cabezuelo, JB;Ramírez, P;Parrilla, P
通讯作者：
Parrilla, P
影响因子：
13.5
作者：
Nair, S;Verma, S;Thuluvath, PJ
通讯作者：
Thuluvath, PJ
影响因子：
2.5
作者：
MCCAULEY, J;VANTHIEL, DH;PUSCHETT, JB
通讯作者：
PUSCHETT, JB
DOI：
10.1097/01.asn.0000079042.13465.1a
发表时间：
2003-08-01
影响因子：
13.6
作者：
Mehta, RL;Chertow, GM
通讯作者：
Chertow, GM
影响因子：
13.6
作者：
Contreras, G;Garces, G;Gomez, E
通讯作者：
Gomez, E