Department of Anesthesiology, University of California San Diego, La Jolla, CA, USA.
Department of Biomedical Informatics, University of California San Diego, La Jolla, CA, USA.
Korean J Anesthesiol. 2020 Feb;73(1):30-35. doi: 10.4097/kja.19108. Epub 2019 Aug 3.
Despite improvements in techniques and management of liver transplant patients, numerous perioperative complications that contribute to perioperative mortality remain. Models to predict intraoperative massive blood transfusion, prolonged mechanical ventilation, or in-hospital mortality in liver transplant recipients have not been identified. In this study we aim to identify preoperative factors associated with the above mentioned complications.
A retrospective observational analysis was conducted on data collected from 124 orthotopic liver transplants performed at a single institution between 2014 and 2017. A multivariable logistic regression using backwards elimination was performed for three defined outcomes (massive transfusion ≥ 10 units packed red blood cells (PRBC), prolonged mechanical ventilation > 24 h, and in-hospital mortality) to identify associations with preoperative characteristics.
Statistically significant (P < 0.05) associations with massive transfusion ≥ 10 units PRBC were hepatocellular carcinoma and preoperative transfusion of PRBC. Significant associations with prolonged mechanical ventilation > 24 h were hepatitis C, alcoholic hepatitis, elevated preoperative ALT, and hepatorenal syndrome. Male gender was protective for requiring prolonged mechanical ventilation. End-stage renal disease and hepatitis B were significantly associated with increased in-hospital mortality.
This study identified risk factors associated with common perioperative complications of liver transplantation. These factors may assist practitioners in risk stratification and may form the basis for further investigations of potential interventions to mitigate these risks.
尽管肝移植患者的技术和管理有所改善，但仍存在许多导致围手术期死亡的围手术期并发症。尚未确定预测肝移植受者术中大量输血、延长机械通气或住院死亡率的模型。在这项研究中，我们旨在确定与上述并发症相关的术前因素。
对 2014 年至 2017 年在一家机构进行的 124 例原位肝移植的数据进行回顾性观察分析。使用向后消除法对三个定义的结果（大量输血≥10 单位浓缩红细胞（PRBC）、延长机械通气>24 小时和住院死亡率）进行多变量逻辑回归分析，以确定与术前特征的关联。
与大量输血≥10 单位 PRBC 相关的统计学显著（P <0.05）因素是肝细胞癌和术前 PRBC 输血。与延长机械通气>24 小时相关的显著因素是丙型肝炎、酒精性肝炎、术前 ALT 升高和肝肾综合征。男性性别对需要延长机械通气有保护作用。终末期肾病和乙型肝炎与住院死亡率增加显著相关。
本研究确定了与肝移植常见围手术期并发症相关的危险因素。这些因素可能有助于医生进行风险分层，并可能为进一步研究潜在干预措施以减轻这些风险提供基础。
