Fluids administration and coagulation characteristics in patients with different model for end-stage liver disease scores undergoing orthotopic liver transplantation
- Author:
- No author available
- Journal Title:
- CHINESE MEDICAL JOURNAL
- Issue:
- 22
- DOI:
- No doi available
- Key Word:
- liver transplantation;fluid therapy;coagulation,blood
Abstract： Background There have been many studies investigating the impact of the model for end-stage liver disease (MELD) score on predicting post-transplant outcome. But it is unclear whether MELD is correlated to intraoperative fluid therapy and coagulation status. We investigated the relationship between the severity of liver diseases as measured by MELD score and intraoperative fluid requirements and the changes of coagulation characteristics. Methods Ninety patients were included in this retrospective study. The patients were stratified into three groups according to the MELD scores: ＜15 (low), 15-25 (medium) and ＞25 (high). Intraoperatively, volume was restored with allogeneic and/or salvaged red blood cells (RBC), fresh-frozen plasma (FFP), platelet and other types of fluids according to hemodynamic data, hematocrit, and clotting data. Intraoperative coagulation data, blood requirements and other fluids administered were compared among the 3 groups. Results Before surgery, in addition to the three variables used to calculate MELD scores in other baseline laboratory values, including ratio of activated partial thromboplastin time (R-APTT), D-Dimer, hematocrit, platelet and blood urea nitrogen (BUN) were significantly different among the 3 groups. The blood loss increased with increasing MELD. The volume of RBC (allogeneinc, salvaged and total), FFP, platelet and the total volume of transfusion were also significantly different among the three groups (P＜0.01). The requirements for prothrombin complex and fibrinogen showed a similar pattern. During operation, the changing trends of each coagulation variable were different. Compared with baseline, during each intraoperative stage, INR and R-APPT increased in the low MELD group. While in the medium MELD and high MELD groups, INR did not changed significantly during the operation, and R-APPT significantly increased only after reperfusion. Conclusions This study provided some useful information for perioperative management of patients undergoing liver transplantation. Careful preoperative planning and resource preparation are crucial for patients with high MELD scores. Close communication between surgeon, anesthesiologist and the transfusion staff of blood bank before and during surgery should be stressed.
- [1]夏杰华,黄文起,黑子清,等.原位肝脏移植术中血液保护的临床研究[J].2002,(7).
- [2]Balzano Antonio,Guardascione MariaA,Amitrano Lucio,etc.Coagulation disorders in liver disease.[J].2002,22(1).
- [3]A L, Buenadicha,L G, Martín,E E, Martín,etc.Assessment of short-term survival after liver transplant by the Model for End-Stage Liver Disease.[J].2005,37(9).
- [4]Levy MF,Chinnakotla S,Goldstein RM,etc.A correlation between the pretransplantation MELD score and mortality in the first two years after liver transplantation.[J].2003,9(2).
- [5]Foxton, M. R.,Kendrick, S.,Sizer, E.,etc.Change in model for end-stage liver disease score on the transplant waiting list predicts survival in patients undergoing liver transplantation:[J].2006,19(12).
- [6]Y, Kang,L M, Borland,J, Picone,etc.Intraoperative coagulation changes in children undergoing liver transplantation.[J].1989,71.
- [7]T V, Cacciarelli,E B, Keeffe,D H, Moore,etc.Primary liver transplantation without transfusion of red blood cells.[J].1996,120(4).
- [8]Niemann CU,Hirose R,Stock P,etc.Intraoperative fluid management of living donor versus cadaveric liver transplant recipients.[J].2004,36(5).
- [9]Colle I,Hemptinne B,Troisi R,etc.Impact of MELD on short-term and long-term outcome following liver transplantation: a European perspective.[J].2005,17(8).
- [10]Niwa N,Maekawa T,Kimura S,etc.Intraoperative blood loss during living donor liver transplantation: an analysis of 635 recipients at a single center.[J].2005,45(6).
- [11]Jacob M,Lewsey JD,van der Meulen JH,etc.Pretransplant MELD score and post liver transplantation survival in the UK and Ireland.[J].2004,10(7).
- [12]Saab S,Morrisey M,Busuttil RW,etc.MELD score predicts 1-year patient survival post-orthotopic liver transplantation.[J].2003,9(5).
- [13]Brooks JP,Holland LL.Toward rational fresh frozen plasma transfusion: The effect of plasma transfusion on coagulation test results.[J].2006,126(1).
- [14]K Q, Hu,A S, Yu,L, Tiyyagura,etc.Hyperfibrinolytic activity in hospitalized cirrhotic patients in a referral liver unit.[J].2001,96(5).
- [15]Cucchetti A,Del Gaudio M,Tuci F,etc.Liver transplantation with the Meld system: a prospective study from a single European center.[J].2006,6(7).
- [16]Masahiro Murakawa.Coagulation monitoring and management during liver transplantation[J].2003,17(2).
- [17]Rudow DL,Emond JC,Russo MW,etc.Model for end-stage liver disease and Child-Turcotte-Pugh score as predictors of pretransplantation disease severity, posttransplantation outcome, and resource utilization in United Network for Organ Sharing status 2A patients.[J].2002,8(3).
- [18]Levin P,Hiatt JR,Busuttil RW,etc.Preoperative characteristics and intraoperative transfusion and vasopressor requirements in patients with low vs. high MELD scores.[J].2006,12(4).
- [19]Steib A,Freys G,Lehmann C,etc.Intraoperative blood losses and transfusion requirements during adult liver transplantation remain difficult to predict.[J].2001,48(11).
- [20]Rettke SR,Findlay JY.Poor prediction of blood transfusion requirements in adult liver transplantations from preoperative variables.[J].2000,12(4).