Platelet Transfusion During Liver Transplantation Is Associated with Increased Postoperative Mortality Due to Acute Lung Injury

Pereboom, Ilona T. A.; Boer, Marieke T. de; Haagsma, Elizabeth B.; Hendriks, Herman G. D.; Lisman, Ton; Porte, Robert J.

doi:10.1213/ane.0b013e3181948a59

Cited by 201 publications

(152 citation statements)

References 38 publications

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“…ADAMTS 13 deficiency is not only associated with NCIPH but is also a significant complication of advanced liver disease of any cause and may contribute to the risks of surgery including liver transplantation. 84 In a recent analysis, platelet transfusion was the only statistically significant factor that could be identified which was associated with excess mortality following liver transplantation. 76 On autopsy evidence, the excess was accounted for by pulmonary 'hepatisation' and right heart failure indicative of platelet driven occlusion of the pulmonary microvasculature.…”

Section: Liver Transplantationmentioning

confidence: 99%

Idiopathic Non-Cirrhotic Intrahepatic Portal Hypertension (NCIPH)—Newer Insights into Pathogenesis and Emerging Newer Treatment Options

Goel

Elias

Eapen

et al. 2014

Journal of Clinical and Experimental Hepatology

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Chronic microangiopathy of portal venules results in idiopathic non-cirrhotic intrahepatic portal hypertension (NCIPH). Recent data suggest a role for vasoactive factors of portal venous origin in the pathogenesis of this 'pure' vasculopathy of the liver. Enteropathies (often silent), are an important 'driver' of this disease. NCIPH is under-recognized and often mis-labeled as cryptogenic cirrhosis. Liver biopsy is needed to prove the diagnosis of NCIPH. In these patients, with advancing disease and increased porto-systemic shunting, the portal venous vasoactive factors bypass the liver filter and contribute to the development of pulmonary vascular endothelial disorders-porto-pulmonary hypertension and hepato-pulmonary syndrome as well as mesangiocapillary glomerulonephritis. Prognosis in NCIPH patients is determined by presence, recognition and management of associated disorders. With better understanding of the pathogenesis of NCIPH, newer treatment options are being explored. Imbalance in ADAMTS 13 (a disintegrin and metalloprotease with thrombospondin type 1 motif, member 13): vWF (von-Willebrand factor) ratio is documented in NCIPH patients and may have a pathogenic role. Therapeutic interventions to correct this imbalance may prove to be important in the management of NCIPH. ( J CLIN EXP HEPATOL 2014;4:247-256) T he term "portal hypertension" is used to reflect a clinical condition secondary to increased pressure in the hepatic portal circulation. Clinically, it usually presents with symptoms or signs of gastroesophageal varices, ascites, encephalopathy, splenomegaly and/or hypersplenism. Portal hypertension can be classified in terms of the anatomic location of the causal resistance to portal blood flow as pre-hepatic (e.g. portal vein thrombosis), post-hepatic (e.g. Budd-Chiari syndrome) and intrahepatic. Intrahepatic portal hypertension can be further sub-classified as pre-sinusoidal (e.g. congenital hepatic fibrosis) or sinusoidal (sinusoidal obstruction syndrome/ veno-occlusive disease). This review focuses on idiopathic non-cirrhotic intrahepatic portal hypertension (NCIPH), a cause of pre-sinusoidal intrahepatic portal hypertension.NCIPH occurs as a consequence of increased resistance to flow within intrahepatic portal vein radicles. Based on vascular corrosion cast and morphometric studies, the site of narrowing or occlusion was localized to the 3rd/4th order portal vein radicles. Boyer 1 and Wanless 2 proposed that the pruning of portal vein radicles is a consequence of thrombosis, but this view is not universally accepted. Sarin et al 3 have shown that there are two independent pressure gradients, one between intra-splenic and intrahepatic pressure and another between intrahepatic and wedged hepatic venous pressure indicating the likelihood of both presinusoidal and peri-sinusoidal resistance to blood flow. Intra-variceal pressure is representative of portal pressure. 3 NOMENCLATUREVarious terminologies have been used in an attempt to define and characterize NCIPH-idiopathic portal hypertensio...

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Section: Liver Transplantationmentioning

confidence: 99%

Idiopathic Non-Cirrhotic Intrahepatic Portal Hypertension (NCIPH)—Newer Insights into Pathogenesis and Emerging Newer Treatment Options

Goel

Elias

Eapen

et al. 2014

Journal of Clinical and Experimental Hepatology

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“…Ancak KT'de kan ürünleri [ES, TDP , trombosit süspansiyonu (TS)] transfüzyonunun artmış morbidite/ mortalite [transfüzyonla ilişkili akut akciğer hasarı (TRALI), enfeksiyon, HAT vb. oranlarında artış] ve yeniden yoğun bakıma yatışla ilişkili olduğunu gösteren birçok kanıt vardır (65)(66)(67)(68)(69)(70)(71). Bu yüzden son kılavuzlarda kan ürünlerinin kullanımı oldukça kısıtlanmıştır.…”

Section: Postoperatif Kanama Koagülasyon Dengesi Ve Transfüzyon Tedaunclassified

Critical Care Management after Adult Liver Transplantation

Akan¹

2017

tybdd

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1ÖZ Karaciğer transplantasyonu uygulanan hastaların yoğun bakım yönetimi çok yönlü bir izlemi ve multidisipliner bir yaklaşımı gerektirir. Günümüzde ideal bir yoğun bakım tedavisi için deneyimli bir ekibe ve gelişmiş yoğun bakım/hastane olanaklarına gereksinim vardır. Karaciğer transplantasyon olgularının postoperatif yoğun bakım yönetimi zaman içinde hızlı bir gelişme göstermiştir. Preoperatif optimizasyon, cerrahi teknik, intraoperatif anestezi yönetimi, organ prezervasyonu, yoğun bakım ve immünosüpresyon tedavilerindeki gelişmeler ile 1998'de %79 düzeyinde olan karaciğer transplantasyonu sonrası bir yıllık sağkalım 2008'de %90'a yükselmiştir. Karaciğer transplantasyonlu olguların yoğun bakım yönetiminde özellikle hızlı kardiyorespiratuvar stabilizasyon, ağır koagülopatinin düzeltilmesi, mekanik ventilasyondan erken ayırma, uygun sıvı-elektrolit tedavisi, böbrek fonksiyonlarının korunması, greft rejeksiyonun önlenmesi ve enfeksiyon profilaksisi/tedavisi büyük önem taşır. Erken postoperatif dönem çok hassas bir süreç olduğundan yakın monitörizasyon, kardiyorespiratuvar fonksiyonların stabilizasyonu, greft fonksiyonunun sık değerlendirilmesi, komplikasyonların erken tanınması ve ekstrahepatik organ yetersizliklerinin hızlı tedavisi mortalite/morbiditenin azaltılabilmesi için zorunludur. Anahtar Kelimeler: Karaciğer transplantasyonu, postoperatif dönem, yoğun bakım, karaciğer yetersizliği ABSTRACT Critical care management after liver transplantation requires a sophisticated monitoring and multi-disciplinary team work. An experienced team and advanced critical care/hospital facilities are necessary for an ideal critical care treatment today. Critical care management after liver transplantation has shown a rapid development since the introduction of liver transplantation. While one-year survival rate after liver transplantation was 79% in 1998, it raised to 90% in 2008 related to the improvements in preoperative optimization, surgical technique, anesthetic management, organ preservation, critial care and immunosuppressive treatment. Treatment of severe coagulopathy, prompt hemodynamic and respiratory stabilization, early weaning from mechanical ventilation, proper fluid-electrolyte therapy, prevention of graft rejection, protection of renal functions and prophylaxis/treatment of infection are particularly important in critical care management after liver transplantation. As early postoperative period of liver transplantation is a critical phase; close monitoring, stabilization of cardiopulmonary functions, frequent evaluation of graft function, early diagnosis of complications and rapid treatment of extrahepatic organ failure are mandatory in order to reduce mortality/morbidity.

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“…Also, there is consensus that the platelet count should not be allowed to fall below 50 × 10 9 /L in patients with acute bleeding [16] . Platelet transfusions have been associated with acute lung injury and decreased survival after orthotopic liver transplantation [103] . An informal survey showed the high degree of variation in practice in the assessment of bleeding risk in patients with liver disease [49] .…”

Section: Clinical Approachmentioning

confidence: 99%

Coagulopathy in liver disease: Lack of an assessment tool

Blasi

2015

WJG

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There is a discrepancy between the information from clotting tests which have routinely been used in clinical practice and evidence regarding thrombotic and bleeding events in patients with liver disease. This discrepancy leads us to rely on other variables which have been shown to be involved in haemostasis in these patients and/or to extrapolate the behaviour of these patients to other settings in order to decide the best clinical approach. The aims of the present review are as follows: (1) to present the information provided by clotting tests in cirrhotic patients; (2) to present the factors that may influence clotting in these patients; (3) to review the clinical evidence; and (4) to put forward a clinical approach based on the first 3 points.

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Platelet Transfusion During Liver Transplantation Is Associated with Increased Postoperative Mortality Due to Acute Lung Injury

Cited by 201 publications

References 38 publications

Idiopathic Non-Cirrhotic Intrahepatic Portal Hypertension (NCIPH)—Newer Insights into Pathogenesis and Emerging Newer Treatment Options

Idiopathic Non-Cirrhotic Intrahepatic Portal Hypertension (NCIPH)—Newer Insights into Pathogenesis and Emerging Newer Treatment Options

Critical Care Management after Adult Liver Transplantation

Coagulopathy in liver disease: Lack of an assessment tool

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