Department of Surgery, Division of Abdominal Transplant, Cancer Center Operations, Saint Louis University, St Louis, Missouri 63110, USA.
Transfusion. 2009 Dec;49(12):2645-51. doi: 10.1111/j.1537-2995.2009.02325.x. Epub 2009 Jul 22.
Excessive use of blood components during liver transplantation should be avoided because it has been associated with poor outcomes and it may stress blood bank resources.
To determine preoperative predictors of excessive transfusion requirements in patients undergoing liver transplantation, the clinical records of 126 consecutive adult patients undergoing primary liver transplantation were retrospectively reviewed. Outcome variables included number of red blood cells (RBCs), plasma, and plateletpheresis components intraoperatively transfused. Univariate analyses of the following predictor variables were performed: recipient age, sex, ethnicity, height/weight, Model for End Stage Liver Disease score, year of transplant, previous abdominal surgery, hepatoma, wait-list time, standard recipient laboratory values obtained immediately before transplantation, cold ischemia time, donor age, sex, and height/weight. Multivariate analysis using logistic regression was used to build a model that best predicted how many blood components should be available before transplant.
Donor age of more than 50 years old (odds ratio [OR], 2.8 95% confidence interval [CI], 1.3-6.0), and recipient serum creatinine (SCr) level of more than 1.3 mg/dL (OR, 3.8 95% CI, 1.6-8.9) were the only variables found to be predictive of RBC use in multivariate analysis. This model accurately predicted the use of more than 10 units of RBCs 79% of cases. Having both adverse factors present resulted in using more than one box in 80% of cases as compared to 44% of cases where only one or no adverse factor was present (p = 0.002). Further analyses showed a direct correlation between the number of RBCs transfused and plasma (r = 0.93) and plateletpheresis components (r = 0.74) transfused. [Corrections added after online publication 22-Jul-2009: OR updated from 3.8 to 2.8; CI from 1.6-8.9 to 1.3-6.0; OR from 2.8-3.8.]
Liver donor's age and recipient's SCr are important in preoperatively predicting blood use during liver transplantation.
肝移植过程中过度使用血液成分应予以避免，因为这与不良预后相关，且可能会给血库资源带来压力。
为了确定肝移植患者术中输血需求过多的术前预测因子，回顾性分析了 126 例连续成年肝移植患者的临床记录。转归变量包括术中输注的红细胞（RBC）、血浆和血小板采集成分的数量。对以下预测因子变量进行单变量分析：受体年龄、性别、种族、身高/体重、终末期肝病模型评分、移植年份、既往腹部手术、肝癌、等待名单时间、移植前即刻获得的标准受体实验室值、冷缺血时间、供体年龄、性别和身高/体重。使用逻辑回归进行多变量分析，以建立最佳预测模型，预测移植前应备有多少血液成分。
供体年龄超过 50 岁（比值比[OR]，2.8；95%置信区间[CI]，1.3-6.0）和受体血清肌酐（SCr）水平超过 1.3 mg/dL（OR，3.8；95% CI，1.6-8.9）是多变量分析中发现的唯一可预测 RBC 使用的变量。该模型准确预测了超过 79%的病例需要使用 10 个单位以上的 RBC。与仅存在一个或不存在不利因素的病例（44%）相比，存在这两个不利因素的病例需要使用超过一个单位的 RBC 达 80%（p = 0.002）。进一步分析显示，输注的 RBC 数量与血浆（r = 0.93）和血小板采集成分（r = 0.74）之间存在直接相关性。[在线出版后 2009 年 7 月 22 日更正：OR 从 3.8 更新为 2.8；CI 从 1.6-8.9 更新为 1.3-6.0；OR 从 2.8-3.8 更新为 2.8-3.8。]
肝供体的年龄和受体的 SCr 是肝移植术中预测血液使用的重要因素。
