Dipartimento di Scienze dell'emergenza, Anestesiologiche e della rianimazione, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy; Università Cattolica del Sacro Cuore, Roma, Italy.
Dipartimento di Diagnostica per immagini, Radioterapia oncologia ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy; Università Cattolica del Sacro Cuore, Roma, Italy.
J Clin Anesth. 2021 May;69:110154. doi: 10.1016/j.jclinane.2020.110154. Epub 2020 Dec 14.
To compare total blood product requirements in liver transplantation (LT) assisted by thromboelastography (TEG) or conventional coagulation tests (CCTs).
Retrospective observational study.
A tertiary care referral center for LT.
Adult patients undergoing LT from deceased donor.
Hemostasis was monitored by TEG or CCTs and corresponding transfusion algorithms were adopted.
Number and types of blood products (red blood cells, RBC; fresh-frozen plasma, FFP; platelets, PLT) transfused from the beginning of surgery until the admission to the intensive care unit.
We compared data retrospectively collected in 226 LTs, grouped according to the type of hemostasis monitoring (90 with TEG and 136 with CCTs, respectively). Confounding variables affecting transfusion needs (recipient age, sex, previous hepatocellular carcinoma surgery, Model for End Stage Liver Disease - MELD, baseline hemoglobin, fibrinogen, creatinine, veno-venous by pass, and trans-jugular intrahepatic portosystemic shunt) were managed by propensity score match (PSM).
The preliminary analysis showed that patients in the TEG group received fewer total blood products (RBC + FFP + PLT; p = 0.001, FFP (p = 0.001), and RBC (p = 0.001). After PSM, 89 CCT patients were selected and matched to the 90 TEG patients. CCT and TEG matched patients received similar amount of total blood products. In a subgroup of 39 patients in the top MELD quartile (MELD ≥25), the TEG use resulted in lower consumption of FFP units and total blood products. Nevertheless, due to the low number of patients, any meaningful conclusion could be achieved in this subgroup.
In our experience, TEG-guided transfusion in LT does not reduce the intraoperative blood product consumption. Further studies are warranted to assess an advantage for TEG in either the entire LT population or the high-MELD subgroup of patients.
比较血栓弹力图（TEG）或常规凝血试验（CCT）辅助下肝移植（LT）中总血制品的需求。
回顾性观察性研究。
LT 的三级保健转诊中心。
接受来自已故供体的 LT 的成年患者。
通过 TEG 或 CCT 监测止血，并采用相应的输血算法。
从手术开始到入住重症监护病房期间输注的血液制品（红细胞、RBC；新鲜冷冻血浆、FFP；血小板、PLT）的数量和类型。
我们回顾性地比较了 226 例 LT 数据，根据止血监测类型进行分组（分别为 90 例 TEG 和 136 例 CCT）。影响输血需求的混杂变量（受者年龄、性别、先前的肝细胞癌手术、终末期肝病模型-MELD、基线血红蛋白、纤维蛋白原、肌酐、静脉-静脉旁路和经颈静脉肝内门体分流术）通过倾向评分匹配（PSM）进行管理。
初步分析表明，TEG 组患者接受的总血制品（RBC+FFP+PLT；p=0.001）、FFP（p=0.001）和 RBC（p=0.001）更少。PSM 后，选择了 89 例 CCT 患者与 90 例 TEG 患者相匹配。CCT 和 TEG 匹配的患者接受了相似数量的总血制品。在 MELD 四分位数最高的 39 例患者亚组（MELD≥25）中，TEG 的使用导致 FFP 单位和总血制品的消耗降低。然而，由于患者数量较少，无法在该亚组中得出任何有意义的结论。
根据我们的经验，TEG 指导的 LT 输血并不能减少术中血制品的消耗。需要进一步的研究来评估 TEG 在整个 LT 人群或 MELD 高的患者亚组中的优势。
