Warnaar N, Molenaar I Q, Colquhoun S D, Slooff M J H, Sherwani S, de Wolf A M, Porte R J
Section Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
J Thromb Haemost. 2008 Feb;6(2):297-302. doi: 10.1111/j.1538-7836.2008.02831.x. Epub 2007 Nov 14.
Pulmonary embolism (PE) and intracardiac thrombosis (ICT) are rare but potentially lethal complications during orthotopic liver transplantation (OLT).
We aimed to review clinical and pathological correlates of PE and ICT in patients undergoing OLT. A systematic review of the literature was conducted using MEDLINE and ISI Web of Science.
Seventy-four cases of intraoperative PE and/or ICT were identified; PE alone in 32 patients (43%) and a combination of PE and ICT in 42 patients (57%). Most frequent clinical symptoms included systemic hypotension and concomitant rising pulmonary artery pressure, often leading to complete circulatory collapse. PE and ICT occurred in every stage of the operation and were reported equally in patients with or without the use of venovenous bypass or antifibrinolytics. A large variety of putative risk factors have been suggested in the literature, including the use of pulmonary artery catheters or certain blood products. Nineteen patients underwent urgent thrombectomy or thrombolysis. Overall mortality was 68% (50/74) and 41 patients (82%) died intraoperatively.
Mortality was significantly higher in patients with an isolated PE, compared to patients with a combination of PE and ICT (91% and 50%, respectively; P < 0.001). Intraoperative PE and ICT during OLT appear to have multiple etiologies and may occur unexpectedly at any time during the procedure.
肺栓塞（PE）和心内血栓形成（ICT）是原位肝移植（OLT）过程中罕见但可能致命的并发症。
我们旨在回顾接受OLT患者中PE和ICT的临床及病理相关性。使用MEDLINE和ISI科学网对文献进行系统回顾。
共识别出74例术中PE和/或ICT病例；32例患者（43%）单独发生PE，42例患者（57%）同时发生PE和ICT。最常见的临床症状包括全身性低血压和肺动脉压同时升高，常导致完全循环衰竭。PE和ICT发生在手术的各个阶段，在使用或未使用静脉-静脉旁路或抗纤溶药物的患者中报告率相同。文献中提出了多种可能的危险因素，包括使用肺动脉导管或某些血液制品。19例患者接受了紧急血栓切除术或溶栓治疗。总体死亡率为68%（50/74），41例患者（82%）在术中死亡。
与同时发生PE和ICT的患者相比，孤立性PE患者的死亡率显著更高（分别为91%和50%；P<0.001）。OLT术中的PE和ICT似乎有多种病因，可能在手术过程中的任何时候意外发生。
