Document Detail


Predictive factors associated with re-exploration for hemostasis in living donor liver transplantation.
MedLine Citation:
PMID:  23274326     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: After liver transplantation (LT), re-exploration of the abdomen to check for bleeding is sometime required. Our study aimed to identify the predictive factors by analysis of preoperative and intraoperative presentations that may impact the re-exploration for hemostasis.
MATERIAL/METHODS: We selected 522 consecutive recipients from the Liver Transplant Program database and medical records between January 1, 1994 and December 1, 2009 in our hospital. Demographic data (age, sex, body mass index, weight, MELD score), preoperative laboratory tests (Hb, platelet, albumin, bilirubin, INR, APTT), and intraoperative presentations (ascites and blood loss, crystalloids, 5% albumin infused, blood products used (such as LPRBC, RBC, FFP, platelet, cryoprecipitate), urine output, Hb at end of operation, and anesthesia) were collected for primary comparison. Potential predictors found by univariate comparison at p<0.1 were put into a multiple binary logistic regression model.
RESULTS: Thirty-eight (7.3%) recipients required re-exploration for hemostasis after LDLT; 80% needed re-exploration only once. In univariate analysis, recipients transfused with FFP >10 ml/kg had a 4.2-fold increased risk of re-exploration (p<0.001). Thirteen potential predictors by univariate comparison at p<0.1 were selected into a multiple binary logistic regression. Fresh frozen plasma (FFP) transfused was the sole predictor.
CONCLUSIONS: Each elevation of 1ml of transfused FFP per kg is associated with a 1.033-fold increased incidence of re-exploration for hemostasis. Patients transfused with more than 10 ml/kg FFP during LT require more intensive management within 72 hours due to increase risk of postoperative bleeding.
Authors:
Shao-Chun Wu; Chao-Long Chen; Chih-Hsien Wang; Chia-Jung Huang; Kwok-Wai Cheng; Tsung-Hsiao Shih; Johnson Chia-Shen Yang; Bruno Jawan
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Publication Detail:
Type:  Evaluation Studies; Journal Article    
Journal Detail:
Title:  Annals of transplantation : quarterly of the Polish Transplantation Society     Volume:  17     ISSN:  2329-0358     ISO Abbreviation:  Ann. Transplant.     Publication Date:  2012 Dec 
Date Detail:
Created Date:  2012-12-31     Completed Date:  2013-05-28     Revised Date:  2013-06-17    
Medline Journal Info:
Nlm Unique ID:  9802544     Medline TA:  Ann Transplant     Country:  Poland    
Other Details:
Languages:  eng     Pagination:  64-71     Citation Subset:  IM    
Affiliation:
Department of Anesthesiology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, No. 123 Dapi Road, Niaosong, Kaohsiung, Taiwan.
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Adult
Blood Loss, Surgical
Blood Transfusion / methods,  standards,  statistics & numerical data
Child
Child, Preschool
Female
Hemostasis, Surgical* / statistics & numerical data
Humans
Liver Transplantation / methods*,  standards
Living Donors*
Logistic Models
Male
Middle Aged
Perioperative Care / methods,  standards,  statistics & numerical data
Plasma
Postoperative Hemorrhage / etiology*,  surgery
Reoperation
Retrospective Studies
Risk Factors
Young Adult

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