Department of Transplantation and Surgery, Semmelweis University, Budapest, Hungary.
Department of Surgery, Division of Transplant Surgery, Medical University Graz, Graz, Austria.
Transplant Proc. 2020 Dec;52(10):2988-2995. doi: 10.1016/j.transproceed.2020.05.006. Epub 2020 Jul 9.
Bloodless liver transplantations (LT) have already been reported, but special characteristics of hemostatic changes remain less defined. The aim of this study was to evaluate the "inevitable" loss of coagulation factors (CF) in blood product-free LT.
Blood product and CF concentrate-free LT patient data were analyzed in terms of the first 2 days of perioperative hemostasis kinetics (N = 59). CF levels (FI, II, V, VII, X, and XIII), platelet (PLT) levels, and hemoglobin levels were measured before LT (T1), on arrival at the intensive care unit (T2), and 12, 24, and 48 hours after LT (T3, T4, and T5, respectively). Thromboelastographic (TEG) parameters were determined before and at the end of LT (T1-T2).
Fibrinogen levels decreased by 1.2 ± 0.6 g/L, prothrombin levels by 26% ± 14%, factor V levels by 40% ± 23%, VII levels by 29% ± 19%, and X levels by 39% ± 22% (P < .001). From T2 to T4 fibrinogen increased by 0.9 ± 0.6g/L for 24 hours (P < .001). Factor II, V, and VII levels increased by 20% ± 16%, 31% ± 32%, and 12% ± 27%, respectively, between T3 and T5 (P < .001). However, factor X reached only half of the T1 level (T3-T5, P < .001). Platelet count increased in 34 (58%) patients at T2 (P < .001). The TEG parameters remained in the normal range during LT (T1-T2).
The major findings of this study advocate that "inevitable" levels of CF decrease during LT by an average of 1.2 g/L in terms of fibrinogen and 23% to 40% regarding factors II, V, VII, and X. The authors suggest that knowing the "magic numbers" and comparing them against baseline laboratory results might predict the possibility of blood product-free transplant, providing confidence and safety to the surgeon and the anesthetist.
已经有报道称进行无血的肝移植（LT），但止血变化的特殊特征仍定义不明确。本研究的目的是评估无血 LT 中凝血因子（CF）的“必然”丢失。
分析了 59 例无血制品和 CF 浓缩物 LT 患者围手术期止血动力学的前 2 天的数据。在 LT 前（T1）、到达重症监护病房时（T2）以及 LT 后 12、24 和 48 小时（T3、T4 和 T5）分别测量 CF 水平（FI、II、V、VII、X 和 XIII）、血小板（PLT）水平和血红蛋白水平。在 LT 前（T1）和结束时（T1-T2）进行血栓弹性图（TEG）参数测定。
纤维蛋白原水平下降 1.2±0.6 g/L，凝血酶原水平下降 26%±14%，因子 V 水平下降 40%±23%，VII 水平下降 29%±19%，X 水平下降 39%±22%（P<0.001）。从 T2 到 T4，24 小时内纤维蛋白原增加 0.9±0.6 g/L（P<0.001）。因子 II、V 和 VII 水平分别在 T3 至 T5 之间增加 20%±16%、31%±32%和 12%±27%（P<0.001）。然而，因子 X 仅达到 T1 水平的一半（T3-T5，P<0.001）。34 名（58%）患者在 T2 时血小板计数增加（P<0.001）。TEG 参数在 LT 期间（T1-T2）保持在正常范围内。
本研究的主要发现表明，在 LT 期间，纤维蛋白原平均下降 1.2 g/L，因子 II、V、VII 和 X 下降 23%至 40%，导致 CF 的“必然”水平下降。作者建议，了解“魔术数字”并将其与基线实验室结果进行比较，可能有助于预测无血制品移植的可能性，为外科医生和麻醉师提供信心和安全性。
