Division of Pulmonary Sciences and Critical Care, University of Colorado, Aurora, CO 80045, USA.
Liver Transpl. 2011 Feb;17(2):149-58. doi: 10.1002/lt.22212.
Patients with chronic liver disease have an increased risk of developing transfusion-related acute lung injury (TRALI) from plasma-containing blood products. Similarly, red blood cell transfusions have been associated with postoperative and nosocomial infections in surgical and critical care populations. Patients undergoing liver transplantation receive large amounts of cellular and plasma-containing blood components, but it is presently unclear which blood components are associated with these postoperative complications. A retrospective cohort study of 525 consecutive liver transplant patients revealed a perioperative TRALI rate of 1.3% (7/525, 95% confidence interval = 0.6%-2.7%), which was associated with increases in the hospital mortality rate [28.6% (2/7) versus 2.9% (15/518), P = 0.02] and the intensive care unit length of stay [2 (1-11 days) versus 0 days (0-2 days), P = 0.03]. Only high-plasma-containing blood products (plasma and platelets) were associated with the development of TRALI. Seventy-four of 525 patients (14.1%) developed a postoperative infection, and this was also associated with increased in-hospital mortality [10.8% (8/74) versus 2.0% (9/451), P < 0.01] and a prolonged length of stay. Multivariate logistic regression determined that the number of transfused red blood cell units (adjusted odds ratio = 1.08, 95% confidence interval = 1.02-1.14, P < 0.01), the presence of perioperative renal dysfunction, and reoperation were significantly associated with postoperative infection. In conclusion, patients undergoing liver transplantation have a high risk of developing postoperative complications from blood transfusion. Plasma-containing blood products were associated with the development of TRALI, whereas red blood cells were associated with the development of postoperative infections in a dose-dependent manner.
患有慢性肝脏疾病的患者在输注含有血浆的血液制品后发生输血相关急性肺损伤（TRALI）的风险增加。同样，红细胞输注与手术和重症监护人群中的术后和医院内感染有关。接受肝移植的患者接受大量的细胞和含有血浆的血液成分，但目前尚不清楚哪些血液成分与这些术后并发症有关。对 525 例连续肝移植患者的回顾性队列研究显示，围手术期 TRALI 发生率为 1.3%（7/525，95%置信区间=0.6%-2.7%），这与医院死亡率的增加有关[28.6%（2/7）与 2.9%（15/518），P=0.02]和重症监护病房住院时间的延长[2（1-11 天）与 0 天（0-2 天），P=0.03]。只有高血浆含量的血液制品（血浆和血小板）与 TRALI 的发生有关。525 例患者中有 74 例（14.1%）发生术后感染，这也与住院死亡率增加有关[10.8%（8/74）与 2.0%（9/451），P<0.01]和住院时间延长。多变量逻辑回归确定，输注的红细胞单位数量（调整后的优势比=1.08，95%置信区间=1.02-1.14，P<0.01）、围手术期肾功能障碍和再次手术与术后感染显著相关。总之，接受肝移植的患者发生输血相关术后并发症的风险很高。含有血浆的血液制品与 TRALI 的发生有关，而红细胞与术后感染的发生呈剂量依赖性相关。
