Fibrinolysis Shutdown Is Associated With Thrombotic and Hemorrhagic Complications and Poorer Outcomes After Liver Transplantation

Autor: Rodrigo Vianna, Mahmoud S. Sleem, Georgia Vasileiou, Yehuda Raveh, Thiago Beduschi, Bhavna P. Singh, Ramona Nicolau-Raducu, Christian Diez
Rok vydání: 2019
Předmět:
Adult
Liver Cirrhosis
Male
medicine.medical_specialty
medicine.medical_treatment
Postoperative Hemorrhage
030204 cardiovascular system & hematology
Gastroenterology
03 medical and health sciences
0302 clinical medicine
Non-alcoholic Fatty Liver Disease
Risk Factors
Internal medicine
Fibrinolysis
medicine
Humans
Blood Transfusion
Hospital Mortality
Intraoperative Complications
Aged
Retrospective Studies
Venous Thrombosis
Transplantation
Hepatology
medicine.diagnostic_test
Platelet Count
business.industry
Incidence
Blood Coagulation Disorders
Middle Aged
medicine.disease
Hyperfibrinolysis
Thrombosis
Thromboelastography
Liver Transplantation
Thrombelastography
Portal vein thrombosis
Pulmonary embolism
Venous thrombosis
Female
030211 gastroenterology & hepatology
Surgery
Packed red blood cells
business
Zdroj: Liver Transplantation. 25:380-387
ISSN: 1527-6473
1527-6465
DOI: 10.1002/lt.25394
Popis: Detrimental consequences of hypofibrinolysis, also known as fibrinolysis shutdown (FS), have recently arisen, and its significance in liver transplantation (LT) remains unknown. To fill this gap, this retrospective study included 166 adults who received transplants between 2016 and 2018 for whom baseline thromboelastography was available. On the basis of percent of clot lysis 30 minutes after maximal amplitude, patients were stratified into 3 fibrinolysis phenotypes: FS, physiologic fibrinolysis, and hyperfibrinolysis. FS occurred in 71.7% of recipients, followed by physiologic fibrinolysis in 19.9% and hyperfibrinolysis in 8.4%. Intraoperative and postoperative venous thrombosis events occurred exclusively in recipients with the FS phenotype. Intraoperative thrombosis occurred with an overall incidence of 4.8% and was associated with 25.0% in-hospital mortality. Incidence of postoperative venous thrombosis within the first month was deep venous thrombosis/pulmonary embolism (PE; 4.8%) and portal vein thrombosis/hepatic vein thrombosis (1.8%). Massive transfusion of ≥20 units packed red blood cells was required in 11.8% of recipients with FS compared with none in the other 2 phenotype groups (P = 0.01). Multivariate analysis identified 2 pretransplant risk factors for FS: platelet count and nonalcoholic steatohepatitis/cryptogenic cirrhosis. Recursive partitioning identified a critical platelet cutoff value of 50 × 109 /L to be associated with FS phenotype. The hyperfibrinolysis phenotype was associated with the lowest 1-year survival (85.7%), followed by FS (95.0%) and physiologic fibrinolysis (97.0%). Infection/multisystem organ failure was the predominant cause of death; in the FS group, 1 patient died of exsanguination, and 1 patient died of massive intraoperative PE. In conclusion, there is a strong association between FS and thrombohemorrhagic complications and poorer outcomes after LT.
Databáze: OpenAIRE
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