Pereboom Ilona T A, de Boer Marieke T, Haagsma Elizabeth B, Hendriks Herman G D, Lisman Ton, Porte Robert J
Department of Surgery, Section Hepatobiliary Surgery and Liver Transplantation, University Medical Center Groningen, Groningen, The Netherlands.
Anesth Analg. 2009 Apr;108(4):1083-91. doi: 10.1213/ane.0b013e3181948a59.
Platelet transfusions have been identified as an independent risk factor for survival after orthotopic liver transplantation (OLT). In this study, we analyzed the specific causes of mortality and graft loss in relation to platelet transfusions during OLT.
In a series of 449 consecutive adult patients undergoing a first OLT, the causes of patient death and graft failure were studied in patients who did or did not receive perioperative platelet transfusions.
Patient and graft survival were significantly reduced in patients who received platelet transfusions, compared with those who did not (74% vs 92%, and 69% vs 85%, respectively at 1 yr; P < 0.001). Lower survival rates in patients who received platelets were attributed to a significantly higher rate of early mortality because of acute lung injury (4.4% vs 0.4%; P = 0.004). There were no significant differences in other causes of mortality between the two groups. The main cause of graft loss in patients receiving platelets was patient death with a functioning graft.
These findings suggest that platelet transfusions are an important risk factor for mortality after OLT. The current study extends previous observations by identifying acute lung injury as the main determinant of increased mortality. The higher rate of graft loss in patients receiving platelets is related to the higher overall mortality rate and does not result from specific adverse effects of transfused platelets on the grafted liver.
血小板输注已被确定为原位肝移植（OLT）后生存的独立危险因素。在本研究中，我们分析了OLT期间与血小板输注相关的死亡和移植物丢失的具体原因。
在一系列连续449例接受首次OLT的成年患者中，研究了接受或未接受围手术期血小板输注患者的死亡原因和移植物失败情况。
与未接受血小板输注的患者相比，接受血小板输注的患者的患者和移植物存活率显著降低（1年时分别为74%对92%，69%对85%；P<0.001）。接受血小板输注的患者生存率较低归因于急性肺损伤导致的早期死亡率显著较高（4.4%对0.4%；P=0.004）。两组之间其他死亡原因无显著差异。接受血小板输注的患者移植物丢失的主要原因是患者死亡且移植物功能正常。
这些发现表明血小板输注是OLT后死亡的重要危险因素。本研究通过将急性肺损伤确定为死亡率增加的主要决定因素，扩展了先前的观察结果。接受血小板输注的患者移植物丢失率较高与总体死亡率较高有关，并非由于输注的血小板对移植肝脏的特定不良影响所致。
