Ersoy Zeynep, Kaplan Serife, Ozdemirkan Aycan, Torgay Adnan, Arslan Gulnaz, Pirat Arash, Haberal Mehmet
Department of Anesthesiology, Baskent University, Ankara, Turkey.
Exp Clin Transplant. 2017 Feb;15(Suppl 1):53-56. doi: 10.6002/ect.mesot2016.O32.
To analyze how graft-weight-to-bodyweight ratio in pediatric liver transplant affects intraoperative and early postoperative hemodynamic and metabolic parameters.
We reviewed data from 130 children who underwent liver transplant between 2005 and 2015. Recipients were divided into 2 groups: those with a graft weight to body weight ratio > 4% (large for size) and those with a ratio ≤ 4% (normal for size). Data included demographics, preoperative laboratory findings, intraoperative metabolic and hemodynamic parameters, and intensive care follow-up parameters.
Patients in the large-graft-for-size group (>4%) received more colloid solution (57.7 ± 20.1 mL/kg vs 45.1 ± 21.9 mL/kg; P = .08) and higher doses of furosemide (0.7 ± 0.6 mg/kg vs 0.4 ± 0.7 mg/kg; P = .018). They had lower mean pH (7.1 ± 0.1 vs 7.2 ± 0.1; P = .004) and PO2 (115.4 ± 44.6 mm Hg vs 147.6 ± 49.3 mm Hg; P = .004) values, higher blood glucose values (352.8 ± 96.9 mg/dL vs 262.8 ± 88.2 mg/dL; P < .001), and lower mean body temperature (34.8 ± 0.7°C vs 35.2 ± 0.6°C; P = .016) during the neohepatic phase. They received more blood transfusions during both the anhepatic (30.3 ± 24.3 mL/kg vs 18.8 ± 21.8 mL/kg; P = .013) and neohepatic (17.7 ± 20.4 mL/kg vs 10.3 ± 15.5 mL/kg; P = .031) phases and more fresh frozen plasma (13.6 ± 17.6 mL/kg vs 6.2 ± 10.2 mL/kg; P = .012) during the neohepatic phase. They also were more likely to be hypotensive (P < .05) and to receive norepinephrine infusion more often (44% vs 22%; P < .05) intraoperatively. More patients in this group were mechanically ventilated in the intensive care unit (56% vs 31%; P = .035). There were no significant differences between the groups in postoperative acute renal dysfunction, graft rejection or loss, infections, length of intensive care stay, and mortality (P > .05).
High graft weight-to-body-weight ratio is associated with adverse metabolic and hemodynamic changes during the intraoperative and early postoperative periods. These results emphasize the importance of using an appropriately sized graft in liver transplant.
分析小儿肝移植中移植物重量与体重之比如何影响术中和术后早期的血流动力学及代谢参数。
我们回顾了2005年至2015年间接受肝移植的130例儿童的数据。受者分为两组：移植物重量与体重之比>4%（相对偏大）的受者和比值≤4%（相对正常）的受者。数据包括人口统计学资料、术前实验室检查结果、术中代谢和血流动力学参数以及重症监护随访参数。
移植物相对偏大组（>4%）的患者术中接受了更多的胶体溶液（57.7±20.1 mL/kg对45.1±21.9 mL/kg；P = 0.08）和更高剂量的呋塞米（0.7±0.6 mg/kg对0.4±0.7 mg/kg；P = 0.018）。在新肝期，他们的平均pH值（7.1±0.1对7.2±0.1；P = 0.004）和PO2值（115.4±44.6 mmHg对147.6±49.3 mmHg；P = 0.004）更低，血糖值更高（352.8±96.9 mg/dL对262.8±88.2 mg/dL；P < 0.001），平均体温更低（34.8±0.7°C对35.2±0.6°C；P = 0.016）。在无肝期（30.3±24.3 mL/kg对18.8±21.8 mL/kg；P = 0.013）和新肝期（17.7±20.4 mL/kg对10.3±15.5 mL/kg；P = 0.031），他们接受了更多的输血，在新肝期接受了更多的新鲜冰冻血浆（13.6±17.6 mL/kg对6.2±10.2 mL/kg；P = 0.012）。术中他们也更易发生低血压（P < 0.05），更常接受去甲肾上腺素输注（44%对22%；P < 0.05）。该组更多患者在重症监护病房需要机械通气（56%对31%；P = 0.035）。两组在术后急性肾功能障碍、移植物排斥或丢失、感染、重症监护住院时间和死亡率方面无显著差异（P > 0.05）。
高移植物重量与体重之比与术中和术后早期不良的代谢和血流动力学变化相关。这些结果强调了在肝移植中使用大小合适的移植物的重要性。
