Gastroenterology, Multivisceral Transplant Unit, Department of Surgery, Oncology and Gastroenterology, Padova University Hospital, Padova, Italy.
Anesthesia Department, Hospital Clinic de Barcelona, Barcelona, Spain.
Best Pract Res Clin Anaesthesiol. 2020 Mar;34(1):35-50. doi: 10.1016/j.bpa.2020.01.003. Epub 2020 Jan 29.
End-stage liver disease is characterized by multiple and complex alterations of hemostasis that are associated with an increased risk of both bleeding and thrombosis. Liver transplantation further challenges the feeble hemostatic balance of patients with decompensated cirrhosis, and the management of antithrombotic treatment during and after transplant surgery, which is particularly difficult. Bleeding was traditionally considered the major concern during and early after surgery, but it is increasingly recognized that transplant recipients may also develop thrombotic complications. Pathophysiology of hemostatic complications during and after transplantation is multifactorial and includes pre-, intra-, and postoperative risk factors. Risk stratification is important, as it helps the identification of high-risk recipients in whom antithrombotic prophylaxis should be considered. In recipients who develop thrombosis during or after surgery, prompt treatment is indicated to prevent graft failure, retransplantation, and death.
终末期肝病的特点是止血功能的多种复杂改变，这与出血和血栓形成的风险增加有关。肝移植进一步挑战了失代偿性肝硬化患者脆弱的止血平衡，并且在移植手术期间和之后的抗血栓治疗管理也特别困难。传统上认为出血是手术期间和早期的主要关注点，但越来越多的人认识到移植受者也可能发生血栓并发症。移植期间和之后止血并发症的病理生理学是多因素的，包括术前、术中和术后的危险因素。风险分层很重要，因为它有助于识别应考虑抗血栓预防的高危受者。对于在手术期间或之后发生血栓形成的受者，应进行及时治疗以预防移植物失功、再次移植和死亡。
