Kaliciński Piotr, Markiewicz Małgorzata, Kamiński Andrzej, Laniewski Przemysław, Ismail Hor, Drewniak Tomasz, Szymczak Marek, Nachulewicz Paweł, Jezierska Elzbieta
Department of Pediatric Surgery and Organ Transplantation, Children's Memorial Health Institute, Warsaw, Poland.
Pediatr Transplant. 2005 Jun;9(3):299-304. doi: 10.1111/j.1399-3046.2005.00309.x.
Large blood loss and transfusions during liver transplantation (LTx) may lead to serious complications and have a negative impact on post-transplant mortality and morbidity. In the retrospective study we compared two groups of recipients of primary cadaveric liver transplantation: group I (study group), consisted of 28 patients with preoperative risk of high intraoperative blood loss, including severe uncorrected coagulopathy. This group was given a bolus of recombinant activated factor VII (rFVIIa) just before LTx. Group II (control group) included 61 patients without a particular risk for increased intraoperative blood loss. These patients were not given rFVIIa. We analyzed both groups for: coagulation parameters before, during and after surgery (INR, APTT, factor VII activity), blood and FFP transfusions, operative time, postoperative complications (vascular thrombosis, reoperation for bleeding), postoperative ICU stay, post-transplant hospitalization time and mortality. Patients from the study group (I) had significantly worse coagulation parameters than patients in the control group (II) at the start of the surgical procedure; however, after administration of a bolus of rFVIIa there was immediate correction of coagulation in all recipients. No significant differences in intraoperative blood transfusions were observed between study and control groups (1980 +/- 311.4 mL vs. 1527 +/- 154.2 mL, respectively), operating time (8.7 h vs. 8.9 h) or ICU and hospital stay (7.03 days vs. 6.15 days and 40.89 days vs. 41.1 days). Re-exploration because of bleeding was performed in three patients from group I (10.7%) and in seven patients (11.5%) from group II. No single case of vascular thrombosis was observed in the study group, while in the control group there were three hepatic artery thromboses, two portal vein thromboses and one hepatic vein thrombosis. We conclude that rFVIIa given preoperatively to liver transplant recipients with several risk factors for high intraoperative bleeding adjusts these patients to a normal risk group, without an increased risk for thrombotic complications.
肝移植（LTx）期间的大量失血和输血可能导致严重并发症，并对移植后的死亡率和发病率产生负面影响。在这项回顾性研究中，我们比较了两组初次尸体肝移植受者：第一组（研究组）由28例术前存在术中高失血风险的患者组成，包括严重的未纠正的凝血病。该组在肝移植前给予一剂重组活化因子VII（rFVIIa）。第二组（对照组）包括61例无术中失血增加特殊风险的患者。这些患者未给予rFVIIa。我们分析了两组患者手术前、手术期间和手术后的凝血参数（国际标准化比值、活化部分凝血活酶时间、因子VII活性）、血液和新鲜冰冻血浆输注情况、手术时间、术后并发症（血管血栓形成、因出血再次手术）、术后重症监护病房停留时间、移植后住院时间和死亡率。在手术开始时，研究组（I）患者的凝血参数明显比对照组（II）患者差；然而，在给予一剂rFVIIa后，所有受者的凝血立即得到纠正。研究组和对照组在术中输血（分别为1980±311.4 mL和1527±154.2 mL）、手术时间（8.7小时对8.9小时）或重症监护病房和住院时间（7.03天对6.15天以及40.89天对41.1天）方面未观察到显著差异。第一组有3例患者（10.7%）因出血进行了再次探查，第二组有7例患者（11.5%）因出血进行了再次探查。研究组未观察到一例血管血栓形成，而对照组有3例肝动脉血栓形成、2例门静脉血栓形成和1例肝静脉血栓形成。我们得出结论，术前给予有多种术中高出血风险因素的肝移植受者rFVIIa可将这些患者调整至正常风险组，且血栓形成并发症风险未增加。
