Brazilian Journal of Anesthesiology
https://app.periodikos.com.br/journal/rba/article/doi/10.1590/S0034-70942011000300003
Brazilian Journal of Anesthesiology
Scientific Article

Associação entre uso de hemocomponentes e mortalidade em cinco anos após transplante hepático

Association between the use of blood components and the five-year mortality after liver transplant

Bruno Salome de Morais; Marcelo Dias Sanches; Agnaldo Soares Lima; Daniel Dias Ribeiro; Teresa Cristina de Abreu Ferrari; Malvina Maria de Freitas Duarte; Guilherme Henrique Gomes Moreira Cançado

http://dx.doi.org/10.1590/S0034-70942011000300003 Braz J Anesthesiol, vol.61, n3, p.289-292, 2011
PDF Português
PDF English
Downloads: 0
Views: 956

Resumo

JUSTIFICATIVA E OBJETIVOS: A cirurgia de transplante hepático (TH) continua associada a sangramento importante em 20% dos casos, e diversos autores têm demonstrado os riscos relacionados ao uso de hemocomponentes. O objetivo deste estudo foi avaliar o impacto do uso de hemocomponentes durante toda a hospitalização na sobrevida em cinco anos de pacientes submetidos a TH. MÉTODOS: Um total de 113 pacientes submetidos ao TH foi avaliado retrospectivamente. Diversas variáveis, incluindo uso de hemocomponentes no intraoperatório e durante toda a hospitalização, foram categorizadas e avaliadas por meio de análise univariada, pelo teste de Fisher. O nível de significância adotado foi de 5%. Os resultados com p < 0,2 foram submetidos a uma análise multivariada pelo modelo de regressão logística multinominal. RESULTADOS: Doenças parenquimatosas, disfunção renal pré-operatória e maior tempo de internação no CTI e hospitalar se associaram a maior mortalidade em cinco anos após o TH (p < 0,05). Ao contrário do uso de hemocomponentes no intraoperatório, a transfusão acumulada de concentrado de hemácias, plasma fresco congelado e concentrado de plaquetas durante toda a internação hospitalar foi associada à maior mortalidade em cinco anos após o transplante de fígado (p < 0,01). CONCLUSÕES: O estudo alerta para a relação existente entre o uso de hemocomponentes durante a hospitalização e o aumento da mortalidade em cinco anos após o TH.

Palavras-chave

CIRURGIA, Transplante, COMPLICAÇÕES, SANGUE

Abstract

BACKGROUND AND OBJECTIVES: Liver transplant (LT) surgery is associated with significant bleeding in 20% of cases, and several authors have demonstrated the risks related to blood components. The objective of the present study was to evaluate the impact of using blood components during hospitalization in five-year survival of patients undergoing LT. METHODS: One hundred and thirteen patients were evaluated retrospectively. Several variables, including the use of blood components intraoperatively and throughout hospitalization, were categorized and evaluated by univariate analysis using Fisher's test. A level of significance of 5% was adopted. Results with p < 0.2 underwent multivariate analysis using multinomial logistic regression. RESULTS: Parenchymal diseases, preoperative renal dysfunction, and longer stay in hospital and ICU are associated with greater five-year mortality after LT (p < 0.05). Unlike the intraoperative use of blood components, the accumulated transfusion of packed red blood cell, frozen fresh plasma, and platelets during the entire hospitalization was associated with greater five-year mortality after liver transplantation (p < 0.01). CONCLUSIONS: This study emphasizes the relationship between the use of blood components during hospitalization and increased mortality in five years after LT.

Keywords

Blood Component Transfusion, Liver Transplantation, Fatal Outcome

References

de Boer MT, Christensen MC, Amussen M. The impact of intraoperative transfusion of platelets and red blood cells on survival after liver transplantation. Anesth Analg. 2008;106:32-44.

Massicotte L, Lenis S, Thibeault L. Reduction of blood product transfusions during liver transplantation. Can J Anaesth. 2005;52:545-546.

Frasco PE, Poterack KA, Hentz JG. A comparison of transfusion requirements between living donation and cadaveric donation liver transplantation relationship to model of end-stage liver disease score and baseline coagulation status. Anesth Analg. 2005;101:30-37.

Mangus RS, Kinsella SB, Nobari MM. Predictors of blood product use in orthotopic liver transplantation using the piggyback hepatectomy technique. Transplant Proc. 2007;39:3207-3213.

Massicotte L, Beaulieu D, Thibeault L. Coagulation defects do not predict blood product requirements during liver transplantation. Transplantation. 2008;85:956-962.

Massicotte L, Sassine MP, Lenis S. Transfusion predictors in liver transplant. Anesth Analg. 2004;98:1245-1251.

Cacciarelli TV, Keeffe EB, Moore DH. Effect of intraoperative blood transfusion on patient outcome in hepatic transplantation. Arch Surg. 1999;134:25-29.

Ramos E, Dalmau A, Sabate A. Intraoperative red blood cell transfusion in liver transplantation: influence on patient outcome, prediction of requirements, and measures to reduce them. Liver Transpl. 2003;9:1320-1327.

Massicotte L, Sassine MP, Lenis S. Survival rate changes with transfusion of blood products during liver transplantation. Can J Anaesth. 2005;52:148-55.

Hendriks HG, Van der Merr J, de Wolf JT. Intraoperative blood transfusion requirement is the main determinant of early surgical reintervention after orthotopic liver transplantation. Transpl Int. 2005;17:673-679.

Hayashi PH, Forman L, Steinberg T. Model for end-stage liver disease score does not predict patient or graft survival in living donor liver transplant recipients. Liver Transpl. 2003;9:737-40.

Onaca NN, Levy MF, Sanchez EQ. A correlation between the pretransplantation MELD score and mortality in the first two years after liver transplantation. Liver Transpl. 2003;9:117-123.

Desai NM, Mange KC, Crawford MD. Predicting outcome after liver transplantation: utility of the model for end stage liver disease and a newly derived discrimination function. Transplantation. 2004;77:99-106.

Habib S, Berk B, Chang CH. MELD and prediction of post-liver transplantation survival. Liver Transpl. 2006;12:440-447.

Adler M, Gavaler JS, Duquesnoy R. Relationship between the diagnosis, preoperative evaluation and prognosis after orthotopic liver transplantation. Ann Surg. 1988;208:196-202.

Nair S, Verma S, Thuluvath P. Pretransplant renal function predicts survival in patients undergoing orthotopic liver tranplantation. Hepatology. 2002;35:1179- 1185.

Afonso RC, Hidalgo R, Zurstrassem MPVC. Impact of renal failure on liver transplantantation survival. Transplant Proc. 2008;40:808-810.

Biancofiore G, Davis CL. Renal dysfunction in the perioperative liver transplant period. Curr Opin Organ Transplant. 2008;13:291-297.

Mangus RS, Kinsella SB, Nobari MM. Predictors of blood product use in orthotopic liver transplantation using the piggyback hepatectomy technique. Transplant Proc. 2007;39:3207-3213.

Marcel RJ, Stegall WC, Suit CT. Continuous small-dose aprotinin controls fibrinolysis during orthotopic liver transplantation. Anesth Analg. 1996;82:1122-1125.

Schoroeder RA, Collins BH, Tuttle-Newhall E. Intraoperative fluid management during orthotopic liver transplantation. J Cardiothorac Vasc Anesth. 2004;18:438-441.

Massicotte L, Lenis S, Thibeault L. Effect of low central venous pressure and phlebotomy on blood product transfusion requirements during liver transplantations. Liver Transpl. 2006;12:117-123.

Butler P, Israel L, Nusbacher J. Blood transfusion in liver transplantation. Transfusion. 1985;25:120-123.

Mor E, Jennings L, Gonwa TA. The impact of operative bleeding on outcome in transplantation of the liver. Surg Gynecol Obstet. 1993;176:219-227.

Raghavan M, Marik PE. Anemia, allogenic blood transfusion, and immunomodulation in the critically ill. Chest. 2005;127:295-307.

Vamvakas EC, Blajchman MA. Transfusion-related immunomodulation (TRIM): an update. Blood Rev. 2007;21:327-348.

Kleinman S, Caulfield T, Chan P. Toward an understanding of transfusion- related acute lung injury: statement of a consensus panel. Transfusion. 2004;44:1774-1789.

Yost CS, Matthay MA, Gropper MA. Etiology of acute pulmonary edema during liver transplantation: a series of cases with analysis of the edema fluid. Chest. 2001;119:219-223.

5dd6c73f0e88257b4113f286 rba Articles
Links & Downloads
2352-2291 (Electronic) 0104-0014 (Printed)
Braz J Anesthesiol ©2024 All rights reserved.

Braz J Anesthesiol

Share this page
Page Sections