Kloesel Benjamin, Kovatsis Pete G, Faraoni David, Young Vanessa, Kim Heung Bae, Vakili Khashayar, Goobie Susan M
Department of Anesthesiology, Critical Care, Perioperative and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA.
Pediatric Transplant Center, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA.
Paediatr Anaesth. 2017 Jul;27(7):718-725. doi: 10.1111/pan.13162. Epub 2017 May 30.
Liver transplantation represents a major surgery involving a highly vascular organ. Reports defining the scope of bleeding in pediatric liver transplants are few.
We conducted a retrospective analysis of liver transplants performed at our pediatric tertiary care center to quantify blood loss, blood product utilization, and to determine predictors for massive intraoperative bleeding.
Pediatric patients who underwent isolated liver transplantation at Boston Children's Hospital between 2011 and 2016 were included. The amount of blood product transfused in the perioperative period and the incidence of postoperative complications were reported. Univariable and multivariable logistic regressions were used to determine predictors for massive bleeding, defined as estimated blood loss exceeding one circulating blood volume within 24 hours.
Sixty-eight children underwent liver transplantation during the study period and were included in the analysis. Multivariable logistic regression analysis identified the following independent predictors of massive bleeding: preoperative hemoglobin level <8.5 g/dL (OR 11.09, 95% CI 1.87-65.76), INR >1.5 (OR 11.62, 95% CI 2.36-57.26), platelet count <100 10 /L (OR 7.92, 95% CI 1.46-43.05), and surgery duration >600 minutes (OR 6.97, 95% CI 0.99-48.92).
Pediatric liver transplantation is associated with substantial blood loss and a significant blood product transfusion burden. A 43% incidence of massive bleeding is reported. Further efforts are needed to improve bleeding management in this high-risk population.
肝移植是一项涉及高血管器官的大型手术。关于小儿肝移植出血范围的报道较少。
我们对在我们的儿科三级护理中心进行的肝移植进行了回顾性分析，以量化失血量、血液制品的使用情况，并确定术中大量出血的预测因素。
纳入2011年至2016年在波士顿儿童医院接受单纯肝移植的儿科患者。报告围手术期输注的血液制品量和术后并发症的发生率。采用单变量和多变量逻辑回归分析来确定大量出血的预测因素，大量出血定义为24小时内估计失血量超过一个循环血容量。
在研究期间，68名儿童接受了肝移植并纳入分析。多变量逻辑回归分析确定了以下大量出血的独立预测因素：术前血红蛋白水平<8.5 g/dL（比值比11.09，95%置信区间1.87 - 65.76），国际标准化比值>1.5（比值比11.62，95%置信区间2.36 - 57.26），血小板计数<100×10⁹/L（比值比7.92，95%置信区间1.46 - 43.05），以及手术持续时间>600分钟（比值比6.97，95%置信区间0.99 - 48.92）。
小儿肝移植伴有大量失血和显著的血液制品输血负担。据报道，大量出血的发生率为43%。需要进一步努力改善这一高危人群的出血管理。
