目的:肝移植受者围手术期凝血管理具有挑战性。使用旋转血栓弹力图(TEG)的粘弹性测试可以帮助量化止血曲线。目前的工作旨在探讨终末期肝病的病因,移植前疾病的严重程度,或移植前血栓或出血并发症与特定的TEG模式相关。
方法:回顾性队列研究。
方法:单四级护理医院。
方法:共1,078例成人肝移植患者。
方法:主要暴露是终末期肝病的病因,分为内在或非内在(例如,胆道梗阻或心血管)。二次暴露为患者术前终末期肝病模型(MELD)评分,Child-Pugh班,术前主要血栓并发症的存在,和大出血并发症。
结果:与非固有肝病患者相比,固有肝病患者(84%)显示出低凝状态(比值比[OR]:3.70,95%置信区间[CI]:1.94-7.07,p<0.0001)和混合TEG模式(OR:4.59,95%CI:2.07-10.16,p=0.0002)。增加的MELD评分与低凝几率相关(OR:1.14,95%CI:1.08-1.19,p<0.0001)和混合TEG模式(OR:1.08,95%CI:1.03-1.14,p=0.0036)。Child-PughC级患者发生低凝的几率较高(OR:8.55,95%CI:3.26-22.42,p<0.0001)和混合模式(OR:12.48,95%CI:3.89-40.03,p<0.0001)。术前主要的血栓并发症与特定的TEG模式无关。尽管观察到与肝脏疾病严重程度的相互作用。
结论:患有内在肝病的肝移植候选者倾向于表现出低凝性TEG模式,而非固有疾病与高凝状态有关。增加终末期肝病的严重程度,正如MELD分数的增加和Child-Pugh分类的提高所证明的那样,也与低凝的TEG模式有关。
OBJECTIVE: Perioperative coagulation management in liver transplantation recipients is challenging. Viscoelastic testing with rotational
thromboelastography (TEG) can help quantify hemostatic profiles. The current work aimed to investigate whether the etiology of end-stage liver disease, pretransplant disease severity, or pretransplant thrombotic or bleeding complications are associated with specific TEG patterns.
METHODS: Retrospective cohort study.
METHODS: Single quaternary care hospital.
METHODS: A total of 1,078 adult liver transplant patients.
METHODS: The primary exposure was the etiology of end-stage liver disease classified as either intrinsic or nonintrinsic (eg, biliary obstruction or cardiovascular). Secondary exposures were patients\' preoperative Model for End-Stage Liver Disease (MELD) score, Child-Pugh class, presence of major preoperative thrombotic complications, and major bleeding complications.
RESULTS: Patients with intrinsic liver disease (84%) showed higher odds of hypocoagulable (odds ratio [OR]: 3.70, 95% confidence interval [CI]: 1.94-7.07, p < 0.0001) and mixed TEG patterns (OR: 4.59, 95% CI: 2.07-10.16, p = 0.0002) compared with those with nonintrinsic disease. Increasing MELD scores correlated with higher odds of hypocoagulable (OR: 1.14, 95% CI: 1.08-1.19, p < 0.0001) and mixed TEG patterns (OR: 1.08, 95% CI: 1.03-1.14, p = 0.0036). Child-Pugh class C was associated with higher odds of hypocoagulable (OR: 8.55, 95% CI: 3.26-22.42, p < 0.0001) and mixed patterns (OR: 12.48, 95% CI: 3.89-40.03, p < 0.0001). Major preoperative thrombotic complications were not associated with specific TEG patterns, although an interaction with liver disease severity was observed.
CONCLUSIONS: Liver transplantation candidates with intrinsic liver disease tend to exhibit hypocoagulable TEG patterns, while nonintrinsic disease is associated with hypercoagulability. Increasing end-stage liver disease severity, as evidenced by increasing MELD scores and higher Child-Pugh classification, was also associated with hypocoagulable TEG patterns.