Transfusion of blood components in liver transplantation and abdominal multiple organ transplantation

doi:10.3969/j.issn.2095-4344.2016.33.013

Abstract

Abstract:

BACKGROUND: The liver transplantation and abdominal multiple organ transplantation are complicated surgeries, characterized by massive blood loss and high blood transfusion requirements.
OBJECTIVE: To explore the characteristics of blood loss and blood transfusion in liver transplantation and abdominal multiple organ transplantation and post-operative survival rate.
METHODS: Clinical data from 192 patients were retrospectively analyzed, including blood transfusion data with the first 24 hours after surgery and post-operative survival rate.
RESULTS AND CONCLUSION: These 192 patients included 177 patients receiving liver transplantation, 2 patients receiving liver and kidney transplantation and 13 patients receiving abdominal multiple organ transplantation. The average intra-operative blood loss of each patient was (2 401.5±3 239.5) mL. The average infusion of red blood cells, platelet, cryoprecipitate and frozen plasma of each patient at the first 24 hours after surgery was (11.3±11.9), (0.8±0.9), (10.7±11.7) U and (2 805.5±1 393.1) mL, respectively. All kinds of blood infusion in the liver cancer group were obviously less than those in the hepatic failure group. The infusion of cryoprecipitate and frozen plasma in the cirrhosis group was obviously less than that in the hepatic failure group, but the infusion of platelet in the cirrhosis group was significantly more than that in the liver cancer group. The infusion of red blood cells from July 2013 to June 2015 was significantly less than that from July 2012 to June 2013. The blood loss, infusion of red blood cells and frozen plasma in the liver transplantation group of cirrhosis were significantly more than those in the abdominal multiple organ transplantation group of cirrhosis (all P < 0.05). In conclusion, diagnosis of liver diseases, and the maturity of surgery exert an effect on the blood loss and blood infusion. As the development of liver transplantation and abdominal multiple organ transplantation, both the blood loss and blood infusion are decreased. Besides, compared with liver transplantation, the blood loss and blood infusion show no increase in the abdominal multiple organ transplantation.

中国组织工程研究杂志出版内容重点：组织构建；骨细胞；软骨细胞；细胞培养；成纤维细胞；血管内皮细胞；骨质疏松；组织工程

Key words: Liver Transplantation, Organ Transplantation, Blood loss, Surgical, Blood Transfusion

CLC Number:

R318

Lin Jing-xia, Su Fan, Luo Hong-shan. Transfusion of blood components in liver transplantation and abdominal multiple organ transplantation[J]. Chinese Journal of Tissue Engineering Research, 2016, 20(33): 4957-4962.

Figures/Tables 1

2.1 参与者数量分析收集192例患者资料，全部进入结果分析。 2.2 肝脏移植患者基本情况分析 192例肝移植及腹部多器官移植，年龄9个月至81岁，平均年龄(49.2±11.9)岁，男169例，女23例。诊断分别为：肝癌87例；肝硬化(乙肝肝硬化55例、胆汁性肝硬化7例、酒精性肝硬化3例、丙肝肝硬化2例、酪氨酸血症1例)68例；肝衰竭15例；慢性乙型重型肝炎11例；其他肝病(肝胆管细胞癌5例、肝胆管朗格汉斯细胞组织细胞增生症1例、肝豆状核变性1例、肝巨大转移性孤立性纤维瘤1例、肝纤维化并肝功能损害1例、布加综合征1例、Ⅰ型原发性高草酸尿症1例)11例。接受手术患者中，肝移植177例，肝肾联合移植2例，腹部多器官移植(肝胰腺十二指肠联合移植)13例。同血型移植191例：A型Rh(D)阳性53例；B型Rh(D)阳性62例；O型Rh(D)阳性63例；AB型Rh(D)阳性13例。血型不合移植1例：AB型Rh(D)阳性接受B型Rh(D)阳性供肝1例。死亡病例13例，其中，2例为术中突然出现心跳骤停，抢救无效死亡；另11例为术后出现多脏器功能衰竭，抢救无效死亡。存活病例179例，随访时间为3-1 218 d，平均随访时间为(401.2±323.6) d。见表1。 2.3 不同分组类别对肝脏移植输血情况的影响分析接受移植手术患者，手术开始后24 h内红细胞输注量为0-67.5 U，平均红细胞输注量为(11.3±11.9) U；血小板输注量为0-3 U，平均血小板输注量为(0.8±0.9)U；冷沉淀输注量为0-59.5 U，平均冷沉淀输注量为(10.7±11.7) U；血浆输注量为(600-8 350) mL，平均血浆输注量为 (2 805.5±1 393.1) mL。年龄分组或性别分组，各指标差异无显著性意义。不同肝病诊断前4组组间比较：红细胞、血小板、冷沉淀、血浆输注量差异均有显著性意义(F值分别为3.03、10.35、6.30和4.90，P均< 0.05)，肝衰竭患者术中出血最多，输血也最多。两两比较得出：①肝癌组与肝衰竭组输各血液成分差异有显著性意义(均P < 0.05)，即肝癌组的红细胞、血小板、冷沉淀、血浆输注量明显少于肝衰竭组；②肝硬化组与肝衰竭组输冷沉淀和血浆差异有显著性意义(均P < 0.05)，即肝硬化组的冷沉淀、血浆输注量明显少于肝衰竭组；③肝癌组与肝硬化组输血小板差异有显著性意义(P < 0.05)，即肝癌组的血小板输注量明显少于肝硬化组；④其余指标差异均无显著性意义。见表2。 2.4 不同年份对肝脏移植输血情况的分析两段期间比较，红细胞输注量差异有显著性意义(t=0.11，P< 0.05)，即2013年7月至2015年6月期间手术的红细胞输注量明显少于2012年7月至2013年6月，而其余指标差异均无显著性意义。见表3。 2.5 不同手术类别对肝脏移植输血情况的分析同一种肝病诊断的肝移植或腹部多器官移植出血和输血情况：①比较肝癌患者的肝移植手术和多器官移植手术：各指标差异无显著性意义；②比较肝硬化患者的肝移植手术和多器官移植手术：出血量、红细胞、血浆输注量的差异均有显著性意义(t分别为-2.51，-3.30，-0.78，均P< 0.05)，即肝硬化患者的肝移植手术出血量、红细胞、血浆输注量均明显多于肝硬化患者的多器官移植手术，而其余指标差异均无显著性意义。见表4。"

References

[1] 李亭,贺志军.腹部多器官联合移植[J].中华临床医师杂志:电子版,2013,7(1):27-29.
[2] 蒋欣,曲青山,苗书斋.多器官联合移植3例报道[J].中华实用诊断与治疗杂志,2010,24(10):1035-1036.
[3] 鞠卫强,何晓顺,郭志勇,等.肝胰十二指肠器官簇移植术后的免疫抑制治疗[J].中华普通外科学文献(电子版), 2012, 6(1):17-21.
[4] 宋继勇,石炳毅,杜国盛,等.肝肾联合移植患者免疫抑制剂的应用[J].中国组织工程研究与临床康复,2010,14(53): 9953-9956.
[5] 史瑞,沈中阳.多器官联合移植:方兴未艾[J].实用器官移植电子杂志,2014,2(6):330-331.
[6] 姚丹华,李幼生,黎介寿.联合器官移植的研究进展[J].实用器官移植电子杂志,2014,2(6):332-335.
[7] 薄艳,李代红,许建刚,等.不同基础肝病肝移植术围术期的血液保护与成分输血[J].广东医学,2012,33(6):798-800.
[8] 马宏伟,谢辉.肝移植术中成分输血影响因素分析[J].中国实用医药,2013,8(11):32-34.
[9] 邵明,吕先萍,王静,等.肝移植术中输血量的预测因素分析[J].中国输血杂志,2012,25(12):1291-1294.
[10] 何晓顺,鞠卫强,林建伟.腹部多器官移植在我国的临床应用[J].中华移植杂志(电子版),2015,9(2):50-53.
[11] Findlay JY,Fix OK,Paugam-Burtz C,et al. Critical care of the end-stage liver disease patient awaiting liver transplantation. Liver Transpl.2011;17(5):496．
[12] Roullet S,Biais M,Millas E,et al. Risk factors for bleeding and transfusion during orthotopic liver transplantation. Ann Fr Anesth Reanim.2011;30(4):349.
[13] Araujo T,Cordeiro A,Proenca P,et al. Predictive variables affecting transfusion requirements in orthotopic liver transplantation. Transplant Proc.2010; 42(5):1758．
[14] 何晓顺,周健,鞠卫强,等.器官捐献时代的器官移植[J]. 外科理论与实践,2014,19(4):281-284.
[15] 陆森,黄新立,李相成,等.腹部多器官联合切取的技术改进[J].南京医科大学学报(自然科学版),2011,31(9):1395-1398.
[16] 姚嘉,姜楠.2013年中国器官移植大会纪要[J].器官移植, 2014,5(1):57-59.
[17] 华学锋,张彤,洪良庆,等.肝肾联合移植的临床体会(附10例分析)[J].器官移植,2010,1(5):300-304.
[18] 张彤,傅斌生,李华,等.肝癌肝移植围手术期死亡10例分析[J].中国实用外科杂志,2011,31(11):1031-1034.
[19] 李志伟,李超,马继韬,等. 血型不相容肝移植新型策略临床的应用[J]. 中国普通外科杂志,2011,20(1):6-10.
[20] Kim BW, Park YK, Kim YB, et al. Effects and Problems of Adult ABO-Incompatible Living Donor Liver Transplantation Using Protocol of Plasma Exchange, Intra-arterial Infusion Therapy, and Anti-CD20 Monoclonal Antibody Without Splenectomy: Case Reports of Initial Experiences and Results in Korea. Transplant Proc. 2008;40(10):3772- 3777.
[21] Uchiyama H, Mano Y, Taketomi A,et al. Kinetics of anti-blood type isoagglutinin titers and B lymphocytes in ABO-incompatible donor liver transplantation with rituximab and plasma exchange. Transfusion.2011; 92(10): 1134-1139.
[22] Chuan LI, Kai MI, Tian Fu WEN,et al. Risk factor and outcomes of massive red blood cell transfusion following living donor liver transplantation.J Dig Dis. 2012;13(3):161-167.
[23] De Santis GC, Brunetta DM, Nardo M,et al. Preoperative variables associated with transfusion requirements in orthotopic liver transplantation. Transfus Apher Sci. 2014;50(1):99-105.
[24] Rana A, Petrowsky H, Hong JC, et al.Blood transfusion requirement during liver transplantation is an important risk factor for Mortality. J Am Coll Surg. 2013;216(5): 902-907.
[25] Annabel Blasi, Joan Beltran, Arturo Pereira,et al. An assessment of thromboelastometry to monitor blood coagulation and guide transfusion support in liver transplantation. Transfusion.2012;52(9):1989-1998.
[26] 陶羽,吴婷,周皓君,等.肝功能Child-Pugh分级对肝移植患者输血量的影响[J].临床血液学杂志,2012,25(6):373-374.
[27] 刘振红,王淑英,冯艳青,等.原位肝移植患者术中大量输血影响因素分析[J].海南医学,2015,26(23):3471-3474.
[28] 何晓顺,巫林伟,鞠卫强,等.四种不同肝移植手术方式的选择[J].中国医学科学院学报,2008,30(4):426-429.
[29] Ghaffaripour S, Mahmoudi H, Khosravi MB,et al. Preoperative factors as predictors of blood product transfusion requirements in orthotopic liver transplantation. Prog Transplant.2011;21(3):254-259.