De Santis Gil Cunha, Brunetta Denise Menezes, Nardo Mirella, Oliveira Luciana Correa, Souza Fernanda Fernandes, Cagnolati Daniel, Mente Ênio David, Sankarankutty Ajith Kumar, Covas Dimas Tadeu, de Castro e Silva Orlando
Center for Cell-Based Therapy, Medical School of Ribeirão Preto, University of São Paulo, Brazil.
Center for Cell-Based Therapy, Medical School of Ribeirão Preto, University of São Paulo, Brazil.
Transfus Apher Sci. 2014 Feb;50(1):99-105. doi: 10.1016/j.transci.2013.10.006. Epub 2013 Nov 6.
Patients with end-stage chronic liver disease (CLD) and submitted to orthotopic liver transplantation (OLT) usually require blood transfusion during the procedure or in the post-operative period due to hemorrhage. Risk factors for transfusion need are not fully known. This study aimed to identify the factors associated with blood components requirements.
In this retrospective study a total of 166 consecutive patients submitted to OLT with the piggyback technique, between 2001 and 2011, were evaluated for number of blood components transfused during surgical procedure and the four subsequent days (total of 5 days). We evaluated the association between the number of units transfused and clinical variables, such as: Child-Turcotte-Pugh (CTP) and MELD scores, hemoglobin concentration (Hb), INR, serum creatinine, bilirubin and albumin concentrations, and total, hypothermic and normothermic time of graft ischemia.
152 (91.6%) Patients were transfused (median of 24 units of blood components). Risk factors for higher blood transfusion requirements were CTP, INR, Hb and total time of graft ischemia. The group with CTP-A score received less blood components than CTP-B/C (11.5 vs 27; P=0.002). The group with Hb<10 required a higher number of blood units (34.5 vs 23; P=0.003). The group with INR<1.5 received less blood units (20.5 vs 31; P=0.012). The group transplanted with a graft exposed to less than the median of 555 min of ischemia received less transfusion (21 vs 27; P=0.03). MELD score and the other factors were not associated with blood requirements.
These results demonstrate that CTP, but not MELD score, hemoglobin concentration, INR, and total time of graft ischemia are preoperative variables associated with blood requirements during OLT and in the subsequent days.
终末期慢性肝病（CLD）患者接受原位肝移植（OLT）时，由于出血，通常在手术过程中或术后需要输血。输血需求的危险因素尚不完全清楚。本研究旨在确定与血液成分需求相关的因素。
在这项回顾性研究中，对2001年至2011年间采用背驮式技术连续接受OLT的166例患者在手术过程及随后四天（共5天）内输注的血液成分数量进行了评估。我们评估了输注单位数量与临床变量之间的关联，这些变量包括：Child-Turcotte-Pugh（CTP）和MELD评分、血红蛋白浓度（Hb）、国际标准化比值（INR）、血清肌酐、胆红素和白蛋白浓度，以及移植物缺血的总时间、低温和常温时间。
152例（91.6%）患者接受了输血（血液成分中位数为24单位）。输血需求较高的危险因素为CTP、INR、Hb和移植物缺血总时间。CTP-A评分组输注的血液成分少于CTP-B/C组（11.5比27；P=0.002）。Hb<10的组需要更多的血液单位（34.5比23；P=0.003）。INR<1.5的组接受的血液单位较少（20.5比31；P=0.012）。移植的移植物缺血时间少于中位数555分钟的组接受的输血较少（21比27；P=0.03）。MELD评分和其他因素与血液需求无关。
这些结果表明，CTP而非MELD评分、血红蛋白浓度、INR和移植物缺血总时间是OLT及随后几天与血液需求相关的术前变量。
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