From the Département d'Anesthésie et Réanimation (AB, NG, NS, MG, DQ, FA), Département de Chirurgie Hépatobiliaire et de Transplantation hépatique (J-YM) and Centre de Recherche Clinique, Groupement Hospitalier Nord, Hospices Civils de Lyon, Lyon, France (PP, MM).
Eur J Anaesthesiol. 2019 Nov;36(11):825-833. doi: 10.1097/EJA.0000000000001084.
Orthotopic liver transplantation is associated with a risk of bleeding. Coagulation in cirrhotic patients is difficult to assess with standard coagulation tests because of rebalanced coagulation. This can be better assessed by thromboelastometry which can detect coagulation impairments more specifically in such patients.
Our first objective was to compare the number of units of blood products transfused during liver transplantation when using an algorithm based on standard coagulation tests or a thromboelastometry-guided transfusion algorithm.
Randomised controlled trial.
Single-centre tertiary care hospital in France, from December 2014 to August 2016.
A total of 81 adult patients undergoing orthotopic liver transplantation were studied. Patients were excluded if they had congenital coagulopathies.
Transfusion management during liver transplantation was guided either by a standard coagulation test algorithm or by a thromboelastometry-guided algorithm. Transfusion, treatments and postoperative outcomes were compared between groups.
Total number of transfused blood product units during the operative period (1 U is one pack of red blood cells (RBCs), fresh frozen plasma (FFP) or platelets).
Median [interquartile range] intra-operative transfusion requirement was reduced in the thromboelastometry group (3 [2 to 4] vs. 7 [4 to 10] U, P = 0.005). FFP and tranexamic acid were administered less frequently in the thromboelastometry group (respectively 15 vs. 46.3%, P = 0.002 and 27.5 vs. 58.5%, P = 0.005), whereas fibrinogen was more often infused in the thromboelastometry group (72.5 vs. 29.3%, P < 0.001). Median transfusions of FFP (3 [2 to 6] vs. 4 [2 to 7] U, P = 0.448), RBCs (3 [2 to 5] vs. 4 [2 to 6] U, P = 0.330) and platelets (1 [1 to 2] vs. 1 [1 to 2] U, P = 0.910) were not different between groups. In the postoperative period, RBC or platelet transfusion, the need for revision surgery or occurrence of haemorrhage were not different between groups.
A transfusion algorithm based on thromboelastometry assessment of coagulation reduced the total number of blood product units transfused during liver transplantation, particularly FFP administration.
ClinicalTrials.gov identifier: NCT02352181.
原位肝移植会有出血风险。肝硬化患者的凝血情况很难用标准凝血检测来评估，因为凝血已经重新平衡。血栓弹力描记术可以更准确地检测到此类患者的凝血功能障碍，从而更好地进行评估。
我们的首要目标是比较使用基于标准凝血检测的算法或血栓弹力描记术指导的输血算法时，肝移植过程中输注的血液制品单位数量。
随机对照试验。
法国一家单中心三级护理医院，时间为 2014 年 12 月至 2016 年 8 月。
共纳入 81 名接受原位肝移植的成年患者。如果患者有先天性凝血障碍，则将其排除在外。
肝移植期间的输血管理依据标准凝血检测算法或血栓弹力描记术指导的算法进行。比较两组间的输血、治疗和术后结局。
手术期间输注的血液制品单位总数（1 单位是指一袋红细胞（RBC）、新鲜冰冻血浆（FFP）或血小板）。
血栓弹力描记术组术中输血需求中位数[四分位数间距]降低（3 [2 至 4] 与 7 [4 至 10] U，P = 0.005）。血栓弹力描记术组更频繁地使用 FFP（分别为 15 与 46.3%，P = 0.002 和 27.5 与 58.5%，P = 0.005）和氨甲环酸（分别为 15 与 46.3%，P = 0.002 和 27.5 与 58.5%，P = 0.005），但更频繁地输注纤维蛋白原（72.5 与 29.3%，P < 0.001）。FFP（3 [2 至 6] 与 4 [2 至 7] U，P = 0.448）、RBC（3 [2 至 5] 与 4 [2 至 6] U，P = 0.330）和血小板（1 [1 至 2] 与 1 [1 至 2] U，P = 0.910）的输注中位数在两组间无差异。术后 RBC 或血小板输血、再次手术需求或出血发生情况在两组间无差异。
基于血栓弹力描记术评估凝血的输血算法减少了肝移植过程中输注的血液制品单位总数，特别是 FFP 的使用。
ClinicalTrials.gov 标识符：NCT02352181。
