Encuesta sobre el manejo perioperatorio de la hemostasia y transfusión en el trasplante hepático / Survey of hemostasis management and transfusion in liver transplantation

Objetivo. Conocer el manejo de la hemostasia y la práctica transfusional entre los anestesiólogos españoles en el ámbito del trasplante hepático. Método. Se elaboró un cuestionario dirigido a los facultativos especialistas en anestesiología y reanimación de todos los centros que realizan trasplante hepático en España. Los datos requeridos hacían referencia a los 12 meses previos a su distribución, desde el 1 de enero al 31 de diciembre de 2011. Resultados. Se recogieron datos de los 24 centros. Solo el 46% respondieron disponer de protocolos o guías de actuación para el manejo de la hemostasia. El 83% de los centros respondieron conocer el porcentaje de pacientes transfundidos, pero solo el 57% conocía la media de hemoderivados. La mitad respondió estar nada satisfecho con el manejo realizado. La tromboelastometría fue utilizada como método adicional de monitorización en el preoperatorio solo en el 8% de los centros y en un tercio durante el intraoperatorio. El 46% de los centros realizó corrección preoperatoria de los déficits de coagulación basados en test convencionales. En cuanto al consumo de hemoderivados, en el 57% de los centros la media de transfusión de concentrados de hematíes fue ≤ 4. El consumo de plasma fresco congelado fue muy variable, mientras que en el 100% de los centros se consumieron menos de 4 pools de plaquetas por paciente. Conclusiones. Existe una amplia variabilidad en el manejo de la hemostasia y en la práctica transfusional entre los centros españoles. No existen guías de manejo perioperatorio o no son utilizadas ampliamente. Las medias de hemoderivados transfundidos siguen siendo elevadas. Se aprecia un descenso en los centros que utilizan los nuevos métodos de monitorización (AU)

Objective. To determine the management of haemostasis and transfusion practice in the field of liver transplantation in Spain. Methods. A questionnaire was developed for physicians in anaesthesiology of all centres performing liver transplantation in Spain. The information required made reference to the 12 months prior to its distribution, from January 1 to December 31, 2011. Results. Data were collected from 24 centres in which liver transplantation is performed in Spain. Only 46% reported that they had protocols or practice guidelines for the management of haemostasis, and 83% of hospitals responded that they knew the percentage of transfused patients, but only 57% knew the mean transfusion. Regarding the degree of satisfaction with the management of haemostasis/coagulation, 50% said they were not satisfied. Thromboelastometry was used as an additional method of preoperative monitoring in only 8% of the centres and intra-operatively in one-third. Less than half (46%) of the centres performed preoperative correction of coagulation deficits based on conventional tests. The mean number of packed red cells used was ≤ 4 in 57% of centres. Consumption of fresh frozen plasma was highly variable, while 100% of centres consumed less than 4 pools of platelets per patient. Conclusions. There is a wide variability in the management of haemostasis and transfusion practice among Spanish centres. There are no guidelines or they are not widely used. The mean use of transfused blood products remain high. There was a decrease in centres using new methods of monitoring (AU)

Is "intra-operating room" thromboelastometry useful in liver transplantation? A case-control study in 303 patients.

Coagulation monitoring during liver transplantation (LT) is, even today, fundamental to reduce blood loss during surgery. Thromboelastometry (TEM) is a proven technique for controlling the various parameters that influence coagulation. However, there are no studies linking "intra-operating room" TEM (orTEM) with LT outcomes. We describe a case-control study in 303 liver graft recipients analyzing variables associated with operative complications and long-term LT outcomes. The results showed that orTEM reduced the use of blood products in patients with Model for End-Stage Liver Disease scores of ≥ 21, retransplantation, and high surgical difficulty and important intraoperative bleeding. In addition, results in survival and postoperative complications were better when orTEM was used. In conclusion, we confirm that use of orTEM is associated with less use of blood products and a lower rate of complications after LT.

Donor characteristics that are associated with survival in liver transplant recipients older than 70 years with grafts.

INTRODUCTION: The use of grafts from donors older than 70 years of age is increasing due to the decrease in the number of donors and the increase in waiting list patients. MATERIAL AND METHODS: We undertook a univariate and multivariate analysis of 980 adult recipients of whole liver grafts, 129 of them from donors aged 70 years or older. RESULTS: No differences were found in patient survival compared with recipients of younger grafts. There were no higher rates of rejection, vascular or biliary complications, postoperative bleeding, or infections, but older grafts were associated with graft dysfunction (P = .01) and a higher frequency of postoperative refractory ascites (P = .007), but without a greater need for retransplantation. As graft-associated factors, the joint presence in the donor of diabetes (P = .00; confidence interval [CI] = 0.04-0.117), hypertension (P = .00; CI = 0.22-0.39), and weight of more than 90 kg (P = .031; CI = 0.05-0.104) were suggestive of poor prognostic factors in recipient survival. Survival in hepatitis C virus (HCV) recipients or recipients aged older than 60 years was worse with donors aged older than 70 years, although not significantly so. With grafts from donors aged older than 80 years (n = 15), although patient survival rate was good (70% at 10 years), there was a higher rate of retransplantation (20%) and the early mortality rate was 13.3%. CONCLUSIONS: Use of grafts from donors aged older than 70 years is safe, with similar survival to patients with younger grafts. The appearance of initial dysfunction with prolonged ascites may be due to a delay in reaching a correct functionality, but was not associated with increased mortality, complications, or need for retransplantation. It should also be avoided in recipients older than 60 years or with HCV. Grafts older than 80 years were associated with a good long-term patient survival but at the expense of a higher rate of retransplantation. However, it helps to reduce the time on the waiting list and, thus, mortality. We noted decreased survival associated with donor hypertension, diabetes, and obesity, so these donors should be selected more rigorously.

Gestión de la lista de espera para trasplante hepático en Andalucía / No disponible

No disponible

Hemorragia digestiva alta asociada a diverticulosis yeyunal masiva y sobredosificación de Sintrom® / Severe gastrointestinal bleeding associated to massive jejunal diverticulosis and Sintrom® treatment

No disponible