肝移植中的主要血栓栓塞并发症：旋转血栓弹力图和冷沉淀输血的作用

Major Thromboembolic Complications in Liver Transplantation: The Role of Rotational Thromboelastometry and Cryoprecipitate Transfusion.

作者信息

Nguyen-Buckley Christine, Gao Wei, Agopian Vatche, Wray Christopher, Steadman Randolph H, Xia Victor W

机构信息

Department of Anesthesiology and Perioperative Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA.

Department of Anesthesiology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China.

出版信息

Transplantation. 2021 Aug 1;105(8):1771-1777. doi: 10.1097/TP.0000000000003427.

DOI:10.1097/TP.0000000000003427

PMID:32852404

Abstract

BACKGROUND

Although hemorrhage is a major concern during liver transplantation (LT), the risk for thromboembolism is well recognized. Implementation of rotational thromboelastometry (ROTEM) has been associated with the increased use of cryoprecipitate; however, the role of ROTEM-guided transfusion strategy and cryoprecipitate administration in the development of major thromboembolic complications (MTCs) has never been documented.

METHODS

We conducted a study on patients undergoing LT before and after the implementation of ROTEM. We defined MTC as intracardiac thrombus, pulmonary embolism, hepatic artery thrombosis, and ischemic stroke in 30 d after LT. We used a propensity score to match patients during the 2 study periods.

RESULTS

Among 2330 patients, 119 (4.9%) developed MTC. The implementation of ROTEM was significantly associated with an increase in cryoprecipitate use (1.1 ± 1.1 versus 2.9 ± 2.3 units, P < 0.001) and MTC (4.2% versus 9.5%, P < 0.001). Further analysis demonstrated that the use of cryoprecipitate was an independent risk factor for MTC (odds ratio 1.1, 95% confidence interval 1.04-1.24, P = 0.003). Patients with MTC had significantly lower 1-y survival.

CONCLUSIONS

Our study suggests that the implementation of ROTEM and the use of cryoprecipitate play significant roles in the development of MTC in LT. The benefits and risks of cryoprecipitate transfusion should be carefully evaluated before administration.

摘要

背景

尽管出血是肝移植（LT）期间的一个主要问题，但血栓栓塞的风险也已得到充分认识。旋转血栓弹力图（ROTEM）的应用与冷沉淀使用增加有关；然而，ROTEM指导的输血策略和冷沉淀给药在主要血栓栓塞并发症（MTC）发生中的作用尚未见报道。

方法

我们对实施ROTEM前后接受LT的患者进行了一项研究。我们将MTC定义为LT后30天内心腔内血栓、肺栓塞、肝动脉血栓形成和缺血性中风。我们使用倾向评分在两个研究期间对患者进行匹配。

结果

在2330例患者中，119例（4.9%）发生了MTC。ROTEM的实施与冷沉淀使用增加（1.1±1.1单位对2.9±2.3单位，P<0.001）和MTC（4.2%对9.5%，P<0.001）显著相关。进一步分析表明，冷沉淀的使用是MTC的独立危险因素（比值比1.1，95%置信区间1.04-1.24，P=0.003）。发生MTC的患者1年生存率显著降低。