Department of Liver and Vascular Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China.
J Dig Dis. 2012 Mar;13(3):161-167. doi: 10.1111/j.1751-2980.2011.00570.x.
To identify the factors influencing blood loss and secondary blood transfusion and to investigate the outcomes of patients who underwent a massive blood transfusion (MBT) following living donor liver transplantation (LDLT).
Patients who underwent primary adult-to-adult right hepatic lobe LDLT were included in the study, and were divided into the MBT group [≥6 red blood cell (RBC) units in 24 h] and the non-massive blood transfusion (NMBT) group (<6 RBC units in 24 h). All potential risk factors, length of intensive care unit (ICU) stay and long-term survival rate of the patients in the two groups were analyzed.
The data of 181 eligible patients were retrospectively analyzed. A decreased long-term survival rate, a higher incidence of postoperative infection and prolonged ICU stay were observed in the MBT group. No significant difference was observed in survival rate between patients having platelet transfusion>2 units and ≤2 units. Hemoglobin<100 g/L, platelet counts<70×10(9)/L, fibrinogen level<1.5 g/L and history of upper abdominal surgery were found to be independent risk factors.
Blood transfusion during LDLT can be predicted using preoperative variables. Massive RBC transfusion may lead to poor long-term survival, higher postoperative infection rate and prolonged ICU stay. Platelet transfusion may not be a risk factor for long-term survival.
确定影响出血量和二次输血的因素，并调查活体肝移植（LDLT）后接受大量输血（MBT）患者的结局。
本研究纳入了接受成人右半肝活体肝移植的患者，并将其分为 MBT 组[24 小时内输注≥6 个红细胞（RBC）单位]和非大量输血（NMBT）组[24 小时内输注<6 RBC 单位]。分析两组患者的所有潜在危险因素、重症监护病房（ICU）住院时间和长期生存率。
回顾性分析了 181 例符合条件的患者数据。MBT 组患者的长期生存率降低、术后感染发生率较高、ICU 住院时间延长。血小板输注>2 单位和≤2 单位的患者生存率无显著差异。血红蛋白<100 g/L、血小板计数<70×10(9)/L、纤维蛋白原水平<1.5 g/L 和上腹部手术史是独立危险因素。
LDLT 期间输血可通过术前变量预测。大量 RBC 输血可能导致长期生存率降低、术后感染率升高和 ICU 住院时间延长。血小板输注可能不是长期生存的危险因素。
