Hsien Lim, M.D., Chehao Hsu, M.D., Michelle Braunfeld, M.D., Randolph Steadman, M.D., Victor Xia, M.D.
麻醉科，加州大学洛杉矶分校医学中心，洛杉矶，加利福尼亚。

背景：肝脏移植手术（LT）中的移植肝在再灌注之前和/或再灌注之后都会出现大出血。尽管先前已经研究了肝脏移植手术过程中的输血需求，但是对于再灌注后输液需求的某些因素（尤其是与捐赠者有关的因素）却没有完全弄清楚。在该研究中，我们假设肝脏移植手术中的受体和捐赠者均影响再灌注后的输液需求。

方法：经过科研审查委员会（IRB）的批准后，我们回顾性的分析了2004年1月至2005年10月期间进行肝脏移植的成人患者的病例资料（16岁以上）。根据移植肝再灌注之后的红细胞（RBC）和新鲜冷冻血浆（FFP）输血，我们记录并分析了与受体和捐赠者相关的因素。捐赠者因素包括年龄、体重、身高、性别、最高和最低血清钠浓度、持续性低血压、心脏骤停、大泡性脂肪变的严重程度、热缺血和冷缺血时间、高血压病史、糖尿病、抽烟及喝酒等。线性回归、皮尔森卡方检验（Pearson's chi-square test）或费歇尔精确检验（Fisher's exact test），以及t-test都被用于统计分析。Ap < 0.05 时有统计学意义。

结果：在超过21个月的研究期间，共有260例成人患者进行了肝脏移植。肝脏移植时，再灌注后RBC和FFP的输血量分别为5.0±5.7（平均值±标准差，0至57个单位）和6.9±6.5（0至57个单位）。受体肝脏移植前的MELD评分和再灌注前的输液需求与再灌注后输液需求的增加呈正相关(分别为p = 0.003和 0.002)。 再灌注后的输液需求中，除了移植肝大泡性脂肪变的严重程度之外，所有捐赠者的特征都一样。与移植肝大泡性脂肪变低于２０％的患者相比，大泡性脂肪变超过20%的患者再灌注后的输血需求明显更高，同时还需要输入RBC (8.0±5.9 vs 4.6±5.7个单位, p=0.008)和FFP (10.5 vs 6.4±6.3个单位, p=0.007)。

结论：在成人肝移植患者中，再灌注后输液需求的增加与受体MELD评分较高、再灌注前输液量增加、大泡性脂肪变程度较高有关系。因此，再灌注后输液时和处理输液引起的并发症时，应该综合考虑受体和捐赠者的因素。

Both Recipient and Donor Affect Postreperfusion Transfusion Requirements in Liver Transplantation
Hsien Lim, M.D., Chehao Hsu, M.D., Michelle Braunfeld, M.D., Randolph Steadman, M.D., Victor Xia, M.D.
Department of Anesthesiology, UCLA Medical Center, Los Angeles, California

Background: Significant blood loss can occur before or/and after reperfusion of the liver graft in liver transplantation (LT). While total intraoperative transfusion requirements during LT have been studied previously, factors, especially those related to the donor, that are associated with postreperfusion transfusion requirements, are not completely known. We postulate in this study that both recipient and donor affect postreperfusion transfusion requirements in LT.

Methods: After the Institutional Review Board approval, we retrospectively reviewed medical records of adult (age ≥ 16 yr) patients who underwent LT from January 2004 to October 2005. Red blood cell (RBC) and fresh frozen plasma (FFP) transfusions after reperfusion of the liver graft were recorded and analyzed against recipient and donor factors. The donor factors included age, weight, height, gender, highest and last serum sodium concentrations, persistent hypotension, cardiac arrest, extent of macrosteatosis, warm and cold ischemia time, a history of hypertension, diabetes, smoking and alcohol ingestion. Linear regression, Pearson's chi-square test or Fisher's exact test, and Student's test were used for statistical analysis. A p < 0.05 was considered as statistical significance.

Results: A total of 260 adult patients underwent liver transplantation over the 21-month-study period. Postreperfusion RBC and FFP transfusions were 5.0±5.7 (mean±SD, range 0-57 units) and 6.9±6.5 (range 0-55 units) respectively during LT. Recipient pre-LT MELD score and prereperfusion transfusion requirements were positively associated with increased postreperfusion transfusion requirements (p = 0.003 and 0.002, respectively). There were no differences in postreperfusion transfusion requirements regarding to all donor characteristics except for the extent of macrosteatosis of the liver graft. Patients who received the grafts with ≥ 20% macrosteatosis required significantly higher postreperfusion transfusion for both RBC (8.0±5.9 vs 4.6±5.7, in units, p=0.008) and FFP (10.5 vs 6.4±6.3, in units, p=0.007) compared with those who received grafts with < 20% macrosteatosis.

Conclusion: Higher recipient MELD score, increased amount of prereperfusion transfusions, and higher degree of macrosteatosis of the liver graft were associated with increased postreperfusion transfusion requirements in adult LT. Both recipient and donor factors should be considered in planning for postreperfusion transfusion and treatment of transfusion related complications in adult LT.

[责任编辑:刘 聪]