de Boer Marieke T, Molenaar I Quintus, Hendriks Herman G D, Slooff Maarten J H, Porte Robert J
Department of Surgery, Section Hepatobiliary Surgery and Liver Transplantation, University Medical Center Groningen, Groningen, The Netherlands.
Dig Surg. 2005;22(4):265-75. doi: 10.1159/000088056.
Blood loss during liver transplantation has long been recognized as an important cause of morbidity and, especially in the early days, also mortality. It is well known that blood transfusions are associated with an increased risk of postoperative complications, such as infections, pulmonary complications, protracted recovery, and a higher rate of reoperations. Many studies have been performed during the past decades to elucidate the mechanisms of increased blood loss in liver transplantation. In the late 1980s, primary hyperfibrinolysis was identified as an important mechanism of bleeding during liver transplantation. This has provided the scientific basis for the use of antifibrinolytic drugs in liver transplant recipients. Several randomized, controlled studies have shown the efficacy of these compounds in reducing blood loss and transfusion requirements during liver transplantation. In addition, increasing experience and improvements in surgical technique, anesthesiological care and better graft preservation methods have contributed to a steady decrease in blood transfusion requirements in most liver transplant programs. Several centers are now reporting liver transplantation without any need for blood transfusion in up to 30% of their patients. Despite these improvements, most patients undergoing liver transplantation still require blood transfusions that have a negative impact on outcome, emphasizing the need for further attempts to control blood loss by surgeons and anesthesiologists. This paper provides an overview of the clinical and research developments, which have contributed to a reduction in blood loss and transfusion requirements, resulting in an important reduction in morbidity and mortality after liver transplantation during the last two decades.
长期以来，肝移植术中失血一直被认为是发病的重要原因，尤其是在早期，也是死亡的重要原因。众所周知，输血与术后并发症风险增加相关，如感染、肺部并发症、恢复时间延长以及再次手术率升高。在过去几十年里，人们进行了许多研究以阐明肝移植术中失血增加的机制。20世纪80年代后期，原发性纤溶亢进被确定为肝移植术中出血的重要机制。这为在肝移植受者中使用抗纤溶药物提供了科学依据。多项随机对照研究表明，这些药物在减少肝移植术中失血和输血需求方面具有疗效。此外，经验的积累、手术技术、麻醉护理的改进以及更好的移植物保存方法，使得大多数肝移植项目的输血需求稳步下降。现在有几个中心报告称，其高达30%的患者在肝移植时无需输血。尽管有这些改进，但大多数接受肝移植的患者仍需要输血，这对预后有负面影响，强调外科医生和麻醉医生需要进一步努力控制失血。本文概述了临床和研究进展，这些进展有助于减少失血和输血需求，从而在过去二十年中显著降低了肝移植后的发病率和死亡率。
