Chow Jonathan H, Lee Khang, Abuelkasem Ezeldeen, Udekwu Obi R, Tanaka Kenichi A
1 University of Maryland School of Medicine, Baltimore, MD, USA.
2 University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
Semin Cardiothorac Vasc Anesth. 2018 Jun;22(2):164-173. doi: 10.1177/1089253217739689. Epub 2017 Nov 3.
Coagulation management, and transfusion practice in liver transplantation (LT) have been evolving in the recent years due to better understanding of coagulation abnormalities in end-stage liver disease, and clinical management of LT patients. Avoidance of allogeneic blood components is feasible in some patients, but multi-modal coagulation therapies may be necessary in others who develop complex coagulopathy due to hemorrhage, hemodilution, hypothermia, and acid-base disturbances. Transfusions of plasma and cryoprecipitate remain to be the mainstay therapy for procoagulant factor replacement during LT. Clinical efficacy and safety of these products are limited by logistic issues (eg, thawing), and mostly noninfectious complications. Considering potential alternatives to conventional transfusion is thus important to improve hemostatic resuscitation in complex LT cases. The present review is mainly focused on procoagulant properties of plasma and platelet transfusion, and currently available plasma-derived and recombinant factor concentrates, and antifibrinolytic agents in LT patients. The role of viscoelastic coagulation tests to guide specific component therapies will be also discussed.
近年来，由于对终末期肝病凝血异常的深入了解以及肝移植（LT）患者的临床管理，肝移植中的凝血管理和输血实践不断发展。在一些患者中避免使用异体血液成分是可行的，但对于因出血、血液稀释、体温过低和酸碱紊乱而出现复杂凝血病的其他患者，可能需要多模式凝血治疗。在肝移植期间，输注血浆和冷沉淀仍然是补充促凝血因子的主要治疗方法。这些产品的临床疗效和安全性受到后勤问题（如解冻）以及大多为非感染性并发症的限制。因此，考虑传统输血的潜在替代方法对于改善复杂肝移植病例的止血复苏很重要。本综述主要关注血浆和血小板输注的促凝血特性，以及目前可用的血浆源性和重组因子浓缩物，以及肝移植患者使用的抗纤溶药物。还将讨论粘弹性凝血试验在指导特定成分治疗中的作用。
