■原位肝移植(OLT)期间的大出血事件与不良预后相关。与门静脉高压相关的风险比例尚不清楚。肝静脉压力梯度(HVPG)是估计门静脉高压的金标准。这项研究的目的是分析HVPG预测肝硬化患者OLT期间术中主要出血事件的能力。
■我们回顾性分析了一个前瞻性数据库,其中包括2010年至2020年期间接受OLT的所有肝硬化患者,并作为移植前评估的一部分进行了肝和右心导管检查。主要终点是术中大出血事件的发生。
■纳入的468名患者的HVPG中位数为17mmHg[四分位间距,13-22],OLT当天的MELD中位数为16[11-24]。72%的患者需要进行术中红细胞输血(中位数为2个单位输血),平均失血量为1,000毫升[575-1,500]。156例患者(33%)发生术中大出血,与HVPG相关。术前血红蛋白水平,OLT时肝硬化的严重程度(MELD评分,腹水,脑病),止血障碍(血小板减少症,较低的纤维蛋白原水平),和肝硬化的并发症(败血症,急性对慢性肝功能衰竭)。通过反向消除的多元回归分析,HVPG,术前血红蛋白水平,MELD得分,氨甲环酸输注与主要终点相关.根据HVPG确定了三类患者:低风险(HVPG<16mmHg),高风险(HVGP≥16mmHg),和非常高风险(HVPG≥20mmHg)。
■HVPG预测接受OLT的肝硬化患者的大出血事件。将HVPG作为移植前评估的一部分,可以更好地预测术中过程。
原位肝移植(OLT)期间的大出血事件与不良预后相关,但与门静脉高压相关的风险比例尚不清楚。我们的工作表明,肝静脉压力梯度(HVPG),估计门静脉高压症的黄金标准,在接受OLT的肝硬化患者中,是严重出血事件和失血量的强预测因子。根据发生大出血事件的风险可以确定三组患者:HVPG<16mmHg的低危患者,HVPG≥16mmHg的高危患者,和HVPG≥20mmHg的极高危患者。HVPG可以系统地包括在移植前评估中,以预测术中过程并调整患者管理。
UNASSIGNED: Major bleeding events during orthotopic liver transplantation (OLT) are associated with poor outcomes. The proportion of this risk related to portal hypertension is unclear. Hepatic venous pressure gradient (HVPG) is the gold standard for estimating portal hypertension. The aim of this study was to analyze the ability of HVPG to predict intraoperative major bleeding events during OLT in patients with cirrhosis.
UNASSIGNED: We retrospectively analyzed a prospective database including all patients with cirrhosis who underwent OLT between 2010 and 2020 and had liver and right heart catheterizations as part of their pre-transplant assessment. The primary endpoint was the occurrence of an intraoperative major bleeding event.
UNASSIGNED: The 468 included patients had a median HVPG of 17 mmHg [interquartile range, 13-22] and a median MELD on the day of OLT of 16 [11-24]. Intraoperative red blood cell transfusion was required in 72% of the patients (median 2 units transfused), with a median blood loss of 1,000 ml [575-1,500]. Major intraoperative bleeding occurred in 156 patients (33%) and was associated with HVPG, preoperative hemoglobin level, severity of cirrhosis at the time of OLT (MELD score, ascites, encephalopathy), hemostasis impairment (thrombocytopenia, lower fibrinogen levels), and complications of cirrhosis (sepsis, acute-on-chronic liver failure). By multivariable regression analysis with backward elimination, HVPG, preoperative hemoglobin level, MELD score, and tranexamic acid infusion were associated with the primary endpoint. Three categories of patients were identified according to HVPG: low-risk (HVPG <16 mmHg), high-risk (HVGP ≥16 mmHg), and very high-risk (HVPG ≥20 mmHg).
UNASSIGNED: HVPG predicted major bleeding events in patients with cirrhosis undergoing OLT. Including HVPG as part of pre-transplant assessment might enable better anticipation of the intraoperative course.
UNASSIGNED: Major bleeding events during orthotopic liver transplantation (OLT) are associated with poor outcomes but the proportion of this risk related to portal hypertension is unclear. Our work shows that hepatic venous pressure gradient (HVPG), the gold standard for estimating portal hypertension, is a strong predictor of major bleeding events and blood loss volume in patients with cirrhosis undergoing OLT. Three groups of patients can be identified according to their risk of major bleeding events: low-risk patients with HVPG <16 mmHg, high-risk patients with HVPG ≥16 mmHg, and very high-risk patients with HVPG ≥20 mmHg. HVPG could be systematically included in the pre-transplant assessment to anticipate intraoperative course and tailor patient management.