Blasi A, Hessheimer A J, Beltrán J, Pereira A, Fernández J, Balust J, Martínez-Palli G, Fuster J, Navasa M, García-Valdecasas J C, Taurá P, Fondevila C
Anesthesia, Hospital Clínic, University of Barcelona, Barcelona, Spain.
General and Digestive Surgery, Institut de Malalties Digestives i Metabòliques, Hospital Clínic, Centro de Investigación Biomédica en Red Enfermedades Hepáticas y Digestivas (CIBERehd), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain.
Am J Transplant. 2016 Jun;16(6):1901-8. doi: 10.1111/ajt.13621. Epub 2016 Feb 24.
Unexpected donation after circulatory determination of death (uDCD) liver transplantation is a complex procedure, in particular when it comes to perioperative recipient management. However, very little has been published to date regarding intraoperative and immediate postoperative care in this setting. Herein, we compare perioperative events in uDCD liver recipients with those of a matched group of donation after brain death liver recipients. We demonstrate that the former group of recipients suffers significantly greater hemodynamic instability and derangements in coagulation following graft reperfusion. Based on our experience, we recommend a proactive recipient management strategy in uDCD liver transplantation that involves early use of vasopressor support; maintaining adequate intraoperative levels of red cells, platelets, and fibrinogen; and routinely administering tranexamic acid before graft reperfusion.
意外的心脏死亡判定后供肝肝移植（uDCD）是一个复杂的过程，尤其是在围手术期受体管理方面。然而，迄今为止，关于这种情况下的术中及术后即刻护理，发表的内容非常少。在此，我们比较了uDCD肝移植受体与一组匹配的脑死亡后供肝肝移植受体的围手术期情况。我们证明，前一组受体在移植肝再灌注后血流动力学不稳定和凝血紊乱的情况明显更严重。基于我们的经验，我们建议在uDCD肝移植中采取积极的受体管理策略，包括早期使用血管活性药物支持；维持术中足够的红细胞、血小板和纤维蛋白原水平；以及在移植肝再灌注前常规给予氨甲环酸。
