Buzincu Iulian, Blaj Mihaela, Ciumanghel Adi-Ionut, Gîrleanu Irina, Bărbuță Eliza Isabela, Ciumanghel Irina, Trofin Ana-Maria, Lupașcu Cristian Dumitru
"Grigore T. Popa'' University of Medicine and Pharmacy, Iasi, Romania.
Anesthesia and Intensive Care, "St. Spiridon" Emergency Clinical County Hospital, Iasi, Romania.
Medicine (Baltimore). 2025 Jul 25;104(30):e43575. doi: 10.1097/MD.0000000000043575.
Despite advancements in surgical and anesthetic techniques, significant bleeding remains a common challenge during orthotopic liver transplantation (OLT). The extensive nature of the surgical procedure, combined with the patient's fragile coagulation profile, places individuals undergoing OLT at a high risk for massive hemorrhage (MH). Blood transfusions and hemostatic products are frequently required and can be life-saving. However, these resources are often limited, and their use may be associated with numerous complications. This study aimed to evaluate the impact of MH on the day of surgery on the outcomes of patients undergoing OLT from brain-dead donors at our institution. We conducted a retrospective single-center study including all adult patients who underwent OLT from brain-dead donors at the Emergency County Clinical Hospital "Saint Spiridon" in Iași. Preoperative circulating blood volume was calculated for each patient and compared with the estimated blood loss on the day of surgery. Patients who lost >1 circulating blood volume were classified as having experienced MH. The study population was divided into 2 groups: those with MH and those without. Outcomes were assessed based on 30-day and 1-year mortality, as well as medical and surgical complications. The study included 53 patients, with a median blood loss of 5500 mL (4650 mL). MH occurred in 26 patients (49.1%). Patients with a lower body mass index (24.3 vs 26.6, P = .028) and thrombocytopenia (55.5 vs 75 × 10³/µL, P = .04) were more likely to experience MH. Those with MH had higher rates of cardiovascular complications (38.5% vs 7.4%, P = .007), infectious complications (69.2% vs 37%, P = .009), and surgical reintervention (34.6% vs 11.1%, P = .04). Mortality rates at 30 days and 1 year did not significantly differ between patients with and without MH. MH adversely affects the outcomes of OLT patients, as evidenced by increased rates of cardiovascular and infectious complications and a higher likelihood of requiring surgical reintervention.
尽管手术和麻醉技术取得了进步，但在原位肝移植（OLT）过程中，严重出血仍然是一个常见的挑战。手术过程的广泛性，加上患者脆弱的凝血状况，使接受OLT的个体面临大出血（MH）的高风险。经常需要输血和使用止血产品，它们可能挽救生命。然而，这些资源往往有限，而且其使用可能与许多并发症相关。本研究旨在评估手术当天发生的MH对我院接受脑死亡供体OLT患者预后的影响。我们进行了一项回顾性单中心研究，纳入了所有在雅西“圣斯皮里东”县急救临床医院接受脑死亡供体OLT的成年患者。计算每位患者术前循环血容量，并与手术当天的估计失血量进行比较。失血量超过1个循环血容量的患者被归类为发生了MH。研究人群分为两组：发生MH的患者和未发生MH的患者。根据30天和1年死亡率以及医疗和手术并发症评估预后。该研究纳入了53例患者，中位失血量为5500 mL（4650 mL）。26例患者（49.1%）发生了MH。体重指数较低（24.3对26.6，P = 0.028）和血小板减少（55.5对75×10³/µL，P = 0.04）的患者更有可能发生MH。发生MH的患者心血管并发症发生率更高（38.5%对7.4%，P = 0.007）、感染并发症发生率更高（69.2%对37%，P = 0.009）以及手术再次干预率更高（34.6%对11.1%，P = 0.04）。发生MH和未发生MH的患者30天和1年死亡率无显著差异。MH对OLT患者的预后产生不利影响，心血管和感染并发症发生率增加以及需要手术再次干预的可能性更高证明了这一点。
