Anaesthesia Department, Hospital Universitari Bellvitge, Spain.
Anaesthesia Department, Hospital Clinic de Barcelona, IDIBAPS, Spain.
Transfus Apher Sci. 2021 Dec;60(6):103259. doi: 10.1016/j.transci.2021.103259. Epub 2021 Aug 25.
To determine the predictive capacity of baseline haemoglobin and maxim clot firmness (MCF) EXTEM thromboelastometry for intraoperative red blood cell (RBC) requirements and its influence on mortality.
591 adult liver transplant (LT) recipients from ten Spanish centres were reviewed. The main outcomes were the percentage of patients who received RBC and massive transfusion (≥ 6 RBC units), RBC units transfused, and mortality.
76 % received a donor after brain death graft and 24 % a controlled donor after circulatory death graft. Median (interquartile ranges) RBC transfusion was 2 (0-4) units, and 63 % of patients were transfused. Comparing transfused and non-transfused patients, mean (standard deviation) for baseline haemoglobin was 10.4 (2.1) vs. 13.0 (1.9) g/dl (p = 0.001), EXTEM MCF was 51(11) vs. 55(9) mm (p = 0.001). Haemoglobin and EXTEM MCF were inversely associated with the need of transfusion odds ratio (OR) of 0.558 (95 % CI 0.497-0.627, p < 0.001) and OR 0.966 (95 % CI0.945-0.987, p = 0.002), respectively. Pre-operative baseline haemoglobin ≤ 10 g/dL predicted RBC transfusion, sensitivity of 93 % and specificity of 47 %. Massive transfusion (MT) was received by 19 % of patients. Haemoglobin ≤10 g/dL predicted MT with sensitivity 73 % and specificity of 52 %. One-year patient and graft survival were significantly lower in patients who required MT (78 % and 76 %, respectively) vs. those who did not (94 % and 93 %, respectively).
whereas EXTEM MCF is less dreterminant predicting RBC requirements, efforts are required to improve preoperative haemoglobin up to 10 g/dl in patients awaiting LT.
为了确定基线血红蛋白和最大凝块硬度（MCF）EXTEM血栓弹性测定在术中红细胞（RBC）需求中的预测能力及其对死亡率的影响。
回顾了来自西班牙十个中心的 591 名成年肝移植（LT）受者。主要结局是接受 RBC 和大量输血（≥6 个 RBC 单位）、输注 RBC 单位和死亡率的患者比例。
76%的患者接受脑死亡供体移植，24%的患者接受循环死亡供体控制移植。中位数（四分位间距）RBC 输注为 2（0-4）单位，63%的患者接受了输血。与输血和未输血的患者相比，基线血红蛋白的平均值（标准差）分别为 10.4（2.1）g/dl 和 13.0（1.9）g/dl（p=0.001），EXTEM MCF 分别为 51（11）mm 和 55（9）mm（p=0.001）。血红蛋白和 EXTEM MCF 与输血需求呈负相关，优势比（OR）分别为 0.558（95%CI 0.497-0.627，p<0.001）和 0.966（95%CI 0.945-0.987，p=0.002）。术前基线血红蛋白≤10g/dL 预测 RBC 输血，敏感性为 93%，特异性为 47%。19%的患者接受了大量输血（MT）。血红蛋白≤10g/dL 预测 MT 的敏感性为 73%，特异性为 52%。需要 MT 的患者（分别为 78%和 76%）的 1 年患者和移植物存活率明显低于未接受 MT 的患者（分别为 94%和 93%）。
虽然 EXTEM MCF 预测 RBC 需求的能力较低，但需要努力将等待 LT 的患者的术前血红蛋白提高到 10g/dl。
