Department of Medicine University of Chicago Medicine Chicago Illinois USA Department of Internal Medicine University of Colorado Aurora Colorado USA Department of SurgerySchool of Medicine and Public Health University of Wisconsin Madison Wisconsin USA Department of Anesthesiology and Perioperative Medicine Mayo Clinic Jacksonville Florida USA Department of Pathology and Laboratory Medicine Weill Cornell Medicine New York New York USA Department of Interventional Radiology Oregon Health & Science University Portland Oregon USA Department of Medicine Weill Cornell Medicine New York New York USA Department of Anesthesiology University of Wisconsin Madison Wisconsin USA Department of Pathology & Laboratory Medicine University of Wisconsin Madison Wisconsin USA Department of Radiology Northwestern Medicine Chicago Illinois USA Department of Medicine University of Southern California Los Angeles California USA Department of Surgery University of Colorado Aurora Colorado USA Department of Medicine University of Michigan Ann Arbor Michigan USA Department of Medicine and Critical Care University of Alberta Edmonton Alberta Canada Department of Medicine University of VirginiaCharlottesville Virginia USA.
Liver Transpl. 2022 Oct;28(10):1651-1663. doi: 10.1002/lt.26451. Epub 2022 May 13.
Patients with acute and chronic liver disease present with a wide range of disease states and severity that may require liver transplantation (LT). Physiologic alterations occur that are dynamic throughout all phases of perioperative care, creating complex management scenarios that necessitate multidisciplinary clinical care. Specifically, alterations in hemostasis in liver disease can be pronounced and evolve with disease progression over time. Recent studies and society guidance address this emerging paradigm and offer recommendations to assist with hemostatic management in patients with liver disease. However, patients undergoing LT are unique and diverse, often with unstable disease that requires specialized approaches. Our aim is to provide a focused review of hemostatic management of the LT patient, distinguish unique aspects of the three main phases of care (before LT, perioperative, and after LT), and identify knowledge gaps and critical areas of future research.
患有急性和慢性肝脏疾病的患者会出现各种不同的疾病状态和严重程度，可能需要进行肝移植（LT）。患者会出现生理变化，这些变化在围手术期的所有阶段都是动态的，从而产生需要多学科临床护理的复杂管理情况。具体而言，肝脏疾病中的止血功能改变可能很明显，并随着疾病的进展而随时间演变。最近的研究和社会指南解决了这一新兴范例，并提出了一些建议，以帮助肝脏疾病患者进行止血管理。然而，接受 LT 的患者具有独特性和多样性，他们的疾病往往不稳定，需要特殊的方法。我们的目的是对 LT 患者的止血管理进行重点回顾，区分三个主要护理阶段（LT 前、围手术期和 LT 后）的独特方面，并确定知识差距和未来研究的关键领域。
