Cerutti Elisabetta, Stratta Chiara, Romagnoli Renato, Schellino Maria Maddalena, Skurzak Stefano, Rizzetto Mario, Tamponi Giacomo, Salizzoni Mauro
Department of Anesthesiology and Intensive Care, University of Turin, Turin, Italy.
Liver Transpl. 2004 Feb;10(2):289-94. doi: 10.1002/lt.20078.
Living donor liver transplantation (LDLT) is becoming a widespread procedure. However, the risk of surgical and medical complications in healthy donors is still a major concern. Hypercoagulability contributes to thromboembolic complications after surgery, but alterations of hemostasis after liver resection are difficult to predict. This study aims to define the perioperative coagulation profile of living liver donors by the use of both routine tests and thromboelastogram (TEG). Ten subjects undergoing right hepatectomy for LDLT were studied. A complete coagulation screening was performed before operation. The coagulation profile was evaluated by platelet count, prothrombin time-international normalized ratio (PT-INR), activated partial thromboplastin time (aPTT), and TEG at the beginning and at the end of surgery, and on days 1, 3, 5, and 10 after operation, while the donors were under low molecular weight heparin (LMWH) prophylaxis. At preoperative screening, no subject showed evidence of a prothrombotic state. In all cases, TEG was normal at the beginning of surgery. In the postoperative period, despite decreased platelet counts, increased PT-INR, and normal aPTT values, TEG evidenced the progressive development of hypercoagulability in 4 subjects on day 5 and in 6 subjects on day 10. One donor with a definitely hypercoagulable TEG on day 5 experienced deep venous thrombosis (DVT) on day 8, which was resolved with therapeutic doses of LMWH. In conclusion, despite routine tests suggesting hypocoagulability and LMWH prophylaxis, TEG monitoring showed the unexpected occurrence of hypercoagulability in the majority of the subjects after hepatectomy for LDLT. TEG monitoring could be useful in the perioperative management of donors to guide antithrombotic treatment and increase the safety of the procedure.
活体肝移植（LDLT）正成为一种广泛应用的手术。然而，健康供体手术和医疗并发症的风险仍是主要关注点。高凝状态会导致术后血栓栓塞并发症，但肝切除术后止血功能的改变难以预测。本研究旨在通过常规检测和血栓弹力图（TEG）来明确活体肝供体的围手术期凝血情况。对10例接受LDLT右半肝切除术的受试者进行了研究。术前进行了全面的凝血筛查。在手术开始时、结束时以及术后第1、3、5和10天，对受试者进行血小板计数、凝血酶原时间-国际标准化比值（PT-INR）、活化部分凝血活酶时间（aPTT）和TEG检测，同时受试者接受低分子量肝素（LMWH）预防治疗。术前筛查时，无受试者表现出血栓前状态的证据。所有病例手术开始时TEG均正常。术后，尽管血小板计数下降、PT-INR升高且aPTT值正常，但TEG显示4例受试者在术后第5天、6例受试者在术后第10天出现了高凝状态的逐渐发展。1例在术后第5天TEG明确显示高凝的供体在术后第8天发生了深静脉血栓形成（DVT），给予治疗剂量的LMWH后血栓溶解。总之，尽管常规检测提示低凝状态且进行了LMWH预防治疗，但TEG监测显示，在LDLT肝切除术后的大多数受试者中意外出现了高凝状态。TEG监测可能有助于供体的围手术期管理，以指导抗血栓治疗并提高手术安全性。
