Perioperative effects of high doses of intraoperative thymoglobulin induction in liver transplantation

作     者：Lesley De Pietri Valentina Serra Giuseppe Preziosi Gianluca Rompianesi Bruno Begliomini 

作者机构：Division of Anaesthesiology and Intensive Care UnitAzienda Ospedaliero-Universitaria di Modena-Policlinico Liver and Multivisceral Transplant CentreAzienda Ospedaliero-Universitaria di Modena-Policlinico Division of General SurgeryUniversity College London 

出 版 物：《World Journal of Transplantation》 (世界移植杂志)

年 卷 期：2015年第5卷第4期

页      面：320-328页

学科分类：10[医学] 

主　　题：Immunosuppression induction Cytokine release Thymoglobulin Thromboelastography Liver transplant 

摘      要：AIM:To describe our single-centre experience in liver transplantation(LT)with the infusion of high perioperative thymoglobulin *** optimal dosage and timing of thymoglobulin[antithymocyte globulin(ATG)]administration during LT remains *** release syndrome,haemolytic anaemia,thrombocytopenia,neutropenia,fever and serum sickness are potential adverse effects associated with ATG ***:Between December 2009 and December 2010,16 adult non-randomized patients(ATG group),receiving a liver graft from a deceased donor,received an intraoperative infusion(4-6 h infusion)of thymoglobulin(3 mg/kg,ATG:Thymoglobuline).These patients were compared(case control approach)with 16 patients who had a liver transplant without ATG treatment(control group)to evaluate the possible effects of intraoperative ATG *** matching parameters were:Sex,recipient age(±5 years),LT indication including viral status,MELD score(±5 points),international normalized ratio and platelet count(as close as possible).The exclusion criteria for both groups included the following:Multi-organ or living donor transplant,immunosuppressive therapy before transplantation,contraindications to the administration of any thymocyte globulin,human immunodeficiency virus seropositivity,thrombocytopenia[platelet50000/μL]or leukopenia[white blood cells1000/μL].The perioperative side effects(haemodynamic alterations,core temperature variations,colloids and crystalloids requirements,and surgical time)possibly related to ATG infusion and the thromboelastographic(TEG)evaluation of the ATG effects on coagulation,blood loss and blood product transfusion were analysed during the operation and the first three postoperative ***:Intraoperative ATG administration was associated with longer surgical procedures[560±88 min vs 480±83 min(control group),P=0.013],an intraoperative core temperature more than 37℃(50%of ATG patients vs 6.2%of control patients,P=0.015),major intraoperative bloo