Kilercik Hakan, Akbulut Sami, Elsarawy Ahmed, Aktas Sema, Alkara Utku, Sevmis Sinasi
Department of Anesthesiology and Reanimation, Gaziosmanpasa Hospital, Faculty of Medicine, Istanbul Yeni Yuzyil University, 34010 Istanbul, Turkey.
Department of Surgery, Liver Transplant Institute, Faculty of Medicine, Inonu University, 44280 Istanbul, Turkey.
J Clin Med. 2024 Sep 27;13(19):5776. doi: 10.3390/jcm13195776.
: Intraoperative blood transfusion (IOBT) during liver transplantation (LT) has negative outcomes, and it has been shown that an increasing number of these procedures may no longer require IOBT. Regarding living donor liver transplantation (LDLT), the literature on the pre-transplant predictors of IOBT is quite heterogeneous and deficient. In this study, we reviewed our experience of IOBT among a homogenous cohort of adult right-lobe LDLTs. : We conducted a retrospective analysis of prospectively collected data on adult LDLT recipients between January 2018 and October 2023. Two groups were constructed (No-IOBT vs. IOBT) for the exploration of pre- and intraoperative predictors of IOBT using univariate and multivariate analyses. An ROC curve analysis was applied to identify possible cut-offs. The one-year post-LDLT overall survival was compared using the Kaplan-Meier method. A -value < 0.05 was considered statistically significant. : A total of 219 adult LDLT recipients were enrolled. The No-IOBT ( = 56) patients were mostly males ( = 0.016), with higher preoperative levels of HGB ( < 0.001), fibrinogen ( = 0.005), and albumin ( = 0.007) and a lower incidence of pre-transplant upper abdominal surgery ( = 0.017), portal vein thrombosis ( = 0.04), hepatorenal syndrome ( = 0.015), and ascites ( = 0.02) than the IOBT group ( = 163). The No-IOBT group had a shorter anhepatic phase ( = 0.002) and received fewer intravenous crystalloids ( = 0.001). In the multivariate analysis, the pre-transplant HGB ( < 0.001), fibrinogen ( < 0.001), and albumin ( = 0.04) levels were independent predictors of IOBT, showing the following cut-offs in the ROC curve analysis: HGB ≤ 11.5 (AUC: 0.800, < 0.001), fibrinogen ≤ 125 (AUC: 0.638, = 0.0024), and albumin ≤ 3.6 (AUC: 0.663, = 0.0002). These were significantly associated with the No-IOBT group. The one-year overall survival of the No-IOBT and IOBT groups was 100% and 83%, respectively ( = 0.007). : IOBT during LDLT is associated with inferior outcomes. The increased need of IOBT during LT can be predicted by evaluating serum levels of hemoglobin, albumin and fibrinogen before liver transplantation.
肝移植（LT）术中输血（IOBT）会产生不良后果，并且已有研究表明，越来越多的此类手术可能不再需要IOBT。关于活体供肝肝移植（LDLT），术前IOBT预测因素的文献相当参差不齐且存在不足。在本研究中，我们回顾了在一组同质的成人右叶LDLT患者中IOBT的经验。
我们对2018年1月至2023年10月期间前瞻性收集的成人LDLT受者数据进行了回顾性分析。构建了两组（无IOBT组与IOBT组），使用单因素和多因素分析来探索IOBT的术前和术中预测因素。应用ROC曲线分析来确定可能的临界值。使用Kaplan-Meier方法比较LDLT术后一年的总生存率。P值<0.05被认为具有统计学意义。
总共纳入了219例成人LDLT受者。无IOBT组（n = 56）患者大多为男性（P = 0.016），术前血红蛋白（HGB）水平较高（P < 0.001）、纤维蛋白原水平较高（P = 0.005）、白蛋白水平较高（P = 0.007），且移植前上腹部手术发生率较低（P = 0.017）、门静脉血栓形成发生率较低（P = 0.04）、肝肾综合征发生率较低（P = 0.015）、腹水发生率较低（P = 0.02），均低于IOBT组（n = 163）。无IOBT组的无肝期较短（P = 0.002），接受的静脉晶体液较少（P = 0.001）。在多因素分析中，移植前HGB水平（P < 0.001）、纤维蛋白原水平（P < 0.001）和白蛋白水平（P = 0.04）是IOBT的独立预测因素，在ROC曲线分析中显示出以下临界值：HGB≤11.5（AUC：0.800，P < 0.001）、纤维蛋白原≤125（AUC：0.638，P = 0.0024）、白蛋白≤3.6（AUC：0.663，P = 0.0002）。这些与无IOBT组显著相关。无IOBT组和IOBT组的一年总生存率分别为100%和83%（P = 0.007）。
LDLT术中的IOBT与较差的预后相关。通过评估肝移植前血清血红蛋白、白蛋白和纤维蛋白原水平，可以预测LT期间对IOBT需求的增加。
