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ORIGINAL ARTICLE
Year : 2018  |  Volume : 131  |  Issue : 4  |  Page : 426-434

Perioperative Single-Donor Platelet Apheresis and Red Blood Cell Transfusion Impact on 90-Day and Overall Survival in Living Donor Liver Transplantation


Department of Anesthesiology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang 310003, China

Correspondence Address:
Dr. Sheng-Mei Zhu
Department of Anesthesiology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang 310003
China
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0366-6999.225049

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Background: Although many previous studies have confirmed that perioperative blood transfusion is associated with poor outcomes after liver transplantation (LT), few studies described the influence of single-donor platelet apheresis transfusion in living donor LT (LDLT). This study aimed to assess the effect of blood products on outcomes for LDLT recipients, focusing on apheresis platelets. Methods: This retrospective study included 126 recipients who underwent their first adult-to-adult LDLT. Twenty-four variables including consumption of blood products of 126 LDLT recipients were assessed for their link to short-term outcomes and overall survival. Kaplan-Meier survival curve and the log-rank test were used for recipient survival analysis. A multivariate Cox proportional-hazard model and a propensity score analysis were applied to adjust confounders after potential risk factors were identified by a univariate Cox analysis. Results: Patients who received apheresis platelet transfusion had a lower 90-day cumulative survival (78.9% vs. 94.2%, P = 0.009), but had no significant difference in overall survival in the Cox model, compared with those without apheresis platelet transfusion. Units of apheresis platelet transfusion (hazard ratio [HR] = 3.103, 95% confidence interval [CI]: 1.720–5.600, P < 0.001) and preoperative platelet count (HR = 0.170, 95% CI: 0.040–0.730, P = 0.017) impacted 90-day survival independently. Multivariate Cox regression analysis also found that units of red blood cell (RBC) transfusion (HR = 1.036, 95% CI: 1.006–1.067, P = 0.018), recipient's age (HR = 1.045, 95% CI: 1.005–1.086, P = 0.025), and ABO blood group comparison (HR = 2.990, 95% CI: 1.341–6.669, P = 0.007) were independent risk factors for overall survival after LDLT. Conclusions: This study suggested that apheresis platelets were only associated with early mortality but had no impact on overall survival in LDLT. Units of RBC, recipient's age, and ABO group comparison were independent predictors of long-term outcomes.

 

 Abstract in Chinese

活体肝移植围术期单采血小板与红细胞输注影响患者生存

摘要

背景:尽管已有研究证实围术期输血与肝移植术后不良预后相关,但关于单采血小板对活体肝移植预后影响的研究仍缺乏。本研究旨在评估血制品输注对活体肝移植预后的影响,尤其是来自单采血小板的作用。

方法:这是一项基于126例活体肝移植受者临床资料的回顾性研究,本研究评估了包括血制品输注情况在内的24个变量与短期及总体生存情况的关系。生存分析采用Kaplan-Meier曲线及log-rank检验,单因素Cox分析确定潜在危险因素后再使用多因素Cox分析及倾向性评分法调整混杂因素。

结果:输注单采血小板的受者较未输注者90天累积生存率更低 (78.9% vs. 94.2%, P=0.009),但在总体生存率方面却无差别。单采血小板输注单位量 (HR=3.103, 95% CI: 1.720-5.600, P<0.001)及术前血小板计数(HR=0.170, 95% CI: 0.040-0.730, P=0.017)对90天累计生存率有着独立影响。多因素Cox回归分析后还发现,红细胞输注单位量 (HR=1.036, 95% CI: 1.006-1.067, P=0.018), 受者年龄(HR=1.045, 95% CI: 1.005-1.086, P=0.025)及供受者ABO血型相符情况 (HR=2.990, 95% CI: 1.341-6.669, P=0.007)是活体肝移植后影响总体生存的独立危险因素。

结论:本回顾性研究提示单采血小板输注仅与早期死亡率相关而对总体生存情况未产生影响,红细胞输注量、受者年龄与供受者ABO血型相符情况为活体肝移植术后长期生存的独立预测因素。



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