de Jonge Jeroen, Groenland Theo H N, Metselaar Herold J, IJzermans Jan N M, van Vliet Huub H D M, Visser Loes, Tilanus Hugo W
Department of Surgery, Erasmus University Medical Centre Rotterdam, Rotterdam, The Netherlands.
Anesth Analg. 2002 May;94(5):1127-31, table of contents. doi: 10.1097/00000539-200205000-00012.
After the introduction of solvent/detergent-treated plasma (ESDEP) in our hospital, an increased incidence of hyperfibrinolysis was observed (75% vs 29%; P = 0.005) compared with the use of fresh frozen plasma for liver transplantation. To clarify this increased incidence, intraoperative plasma samples of patients treated with fresh frozen plasma or ESDEP were analyzed in a retrospective observational study. During the anhepatic phase, plasma levels of D-dimer (6.58 vs 1.53 microg/mL; P = 0.02) and fibrinogen degradation products (60 vs 23 mg/L; P = 0.018) were significantly higher in patients treated with ESDEP. After reperfusion, differences increased to 23.5 vs 4.7 microg/mL (D-dimer, P = 0.002) and 161 vs 57 mg/L (fibrinogen degradation products, P = 0.001). The amount of plasma received per packed red blood cell concentrate, clotting tests, and levels of individual clotting factors did not show significant differences between the groups. alpha(2)-Antiplasmin levels, however, were significantly lower in patients receiving ESDEP during the anhepatic phase (0.37 vs 0.65 IU/mL; P < 0.001) and after reperfusion (0.27 vs 0.58 IU/mL; P = 0.001). Analysis of alpha(2)-antiplasmin levels in ESDEP alone showed a reduction to 0.28 IU/mL (normal >0.95 IU/mL) because of the solvent/detergent process. Therapeutic consequences for the use of ESDEP in orthotopic liver transplantation are discussed in view of an increased incidence of hyperfibrinolysis caused by reduced levels of alpha(2)-antiplasmin in the solvent/detergent-treated plasma.
The use of solvent/detergent virus-inactivated plasma is of increasing importance in the prevention of human immunodeficiency virus and hepatitis C virus transmission. Since the use of this plasma during orthotopic liver transplantation has increased, the incidence of hyperfibrinolysis was observed. Clotting analysis of the patients revealed small alpha(2)-antiplasmin concentrations because of the solvent/detergent process.
在我院引入溶剂/去污剂处理血浆（ESDEP）后，与肝移植中使用新鲜冰冻血浆相比，观察到高纤溶发生率增加（75%对29%；P = 0.005）。为阐明这一增加的发生率，在一项回顾性观察研究中分析了接受新鲜冰冻血浆或ESDEP治疗患者的术中血浆样本。在无肝期，接受ESDEP治疗的患者血浆D - 二聚体水平（6.58对1.53μg/mL；P = 0.02）和纤维蛋白原降解产物水平（60对23mg/L；P = 0.018）显著更高。再灌注后，差异增加至23.5对4.7μg/mL（D - 二聚体，P = 0.002）和161对57mg/L（纤维蛋白原降解产物，P = 0.001）。每组每单位浓缩红细胞输注的血浆量、凝血试验及各凝血因子水平无显著差异。然而，在无肝期接受ESDEP治疗的患者α2 - 抗纤溶酶水平显著更低（0.37对0.65IU/mL；P < 0.001），再灌注后也是如此（0.27对0.58IU/mL；P = 0.001）。单独分析ESDEP中的α2 - 抗纤溶酶水平显示，由于溶剂/去污剂处理过程，其降至0.28IU/mL（正常>0.95IU/mL）。鉴于溶剂/去污剂处理血浆中α2 - 抗纤溶酶水平降低导致高纤溶发生率增加，讨论了ESDEP在原位肝移植中使用的治疗后果。
溶剂/去污剂病毒灭活血浆在预防人类免疫缺陷病毒和丙型肝炎病毒传播方面的重要性日益增加。由于原位肝移植中这种血浆的使用增加，观察到高纤溶发生率。对患者的凝血分析显示，由于溶剂/去污剂处理过程，α2 - 抗纤溶酶浓度较低。
