Intraoperative thromboelastography as a tool to predict postoperative thrombosis during liver transplantation

作     者：Lesley De Pietri Roberto Montalti Giuliano Bolondi Valentina Serra Fabrizio Di Benedetto 

作者机构：Department of General SurgeryDivision of Anaesthesiology and Intensive Care UnitNuovo Ospedale Civile di SassuoloSassuolo 41049ModenaItaly Department of Public HealthHepato-Pancreato-Biliary Surgery SectionFederico II University of NaplesNapoli 80138Italy Surgery and Trauma DepartmentIntensive Care UnitOspedale Bufalini CesenaCesena 47521Italy Surgery DepartmentHepato-Pancreato-Biliary SurgerySurgical Oncology and Liver Transplantation UnitAzienda Ospedaliero Universitaria di ModenaUniversity of Modena and Reggio EmiliaModena 41125Italy 

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

年 卷 期：2020年第10卷第11期

页      面：345-355页

学科分类：1002[医学-临床医学] 100214[医学-肿瘤学] 10[医学] 

主　　题：Thromboelastography Hepatic artery thrombosis Portal vein thrombosis Liver transplantation Risk factors Cirrhosis 

摘      要：BACKGROUND Thromboembolic complications are relatively common causes of increased morbidity and mortality in the perioperative period in liver transplant *** postoperative portal vein thrombosis(PVT,incidence 2%-2.6%)and early hepatic artery thrombosis(HAT,incidence 3%-5%)have a poor prognosis in transplant patients,having impacts on graft and patient *** the present study,we attempted to identify the predictive factors of these complications for early detection and therefore monitor more closely the patients most at risk of thrombotic *** To investigate whether intraoperative thromboelastography(TEG)is useful in detecting the risk of early postoperative HAT and PVT in patients undergoing liver transplantation(LT).METHODS We retrospectively collected thromboelastographic traces,in addition to known risk factors(cold ischemic time,intraoperative requirement for red blood cells and fresh-frozen plasma transfusion,prolonged operating time),in 27 patients,selected among 530 patients(≥18 years old),who underwent their first LT from January 2002 to January 2015 at the Liver University Transplant Center and developed an early PVT or HAT(case group).Analyses of the TEG traces were performed before anesthesia and 120 min after *** retrospectively compared these patients with the same number of nonconsecutive control patients who underwent LT in the same study period without developing these complications(1:1 match)(control group).The chosen matching parameters were:Patient graft and donor characteristics[age,sex,body mass index(BMI)],indication for transplantation,procedure details,United Network for Organ Sharing classification,BMI,warm ischemia time(WIT),cold ischemia time(CIT),the volume of blood products transfused,and conventional laboratory coagulation *** distributed continuous data are reported as the mean±SD and compared using one-way Analysis of Variance(ANOVA).Nonnormally distributed continuous data are rep