Primary liver transplantation without transfusion of red blood cells.
ABSTRACT This study examines factors associated with the performance of orthotopic liver transplantation (OLT) without red blood cell (RBC) transfusion.
Between January 1992 and December 1994, 306 primary OLTs were performed with recipients divided into two groups: group 1 patients (61 recipients, 20% of total) underwent transplantation without packed RBCs, and group 2 patients (245 recipients, 80% of cases) received a transfusion of at least 1 unit of RBCs during operation.
Recipients in group 1 compared with group 2 had less advanced liver disease (20% hospitalized and 48% Child's class C versus 58% hospitalized and 73% Child's class C, p < 0.01) and lower frequency of right upper quadrant surgery (13% versus 25%, p < 0.05). Group 1 recipients also had significantly higher preoperative hematocrits (38% versus 33%, p < 0.01), lower prothrombin times (15.4 versus 16.7 seconds, p < 0.001) and partial thromboplastin times (36.9 versus 42.2 seconds, p < 0.01), a greater proportion of patients transplanted by piggyback technique (87% versus 59%, p < 0.001), and shorter operative times (7.9 hours versus 9.2 hours, p < 0.001). Moreover, a greater percentage of patients underwent OLT without RBC transfusion in each successive year: 9% in 1992, 21% in 1993, and 31% in 1994 (p < 0.001). Logistic regression analysis showed the following factors to be independent predictors of OLT without RBC transfusion. Preoperative Hct, United Network of Organ Sharing status, piggyback technique, operative time, and year of transplantation.
OLT can be performed without transfusion of RBCs in recipients with less advanced liver disease, and surgical technique, along with increased experience by the transplant team, are important factors.
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ABSTRACT: Purpose of review: Emerging and reemerging fungal infections in solid organ transplant recipients are increasing due to the increase of the population, success of antifungal prophylaxis, and new immunosuppressive treatments. The review aims to describe some of these fungal pathogens and their complex management. Recent findings: An increase of potential fungal pathogens is being described in the solid organ transplant population and, consequently, a rise in the morbidity and mortality of these patients. Clinical trials, both in vivo and in vitro, are being performed to better elucidate clinical response to existing and novel antifungal agents. Most promising are the newer triazoles (voriconazole and posaconazole) and their use in combination with other drug modalities (echinocandins and terbinafine). At the same time, experience has provided some insight into new risk factors and the use of antifungal prophylaxis to minimize the development of fungal infections. Summary: Invasive fungal infections are increasing in solid organ transplant patients. The clinician providing care for this population group will need to have a heightened awareness of possible fungal pathogens to be able to initiate effective treatment early. With the lack of controlled clinical trials, physicians will also have to draw from previously described cases and in-vitro susceptibility testing to optimize therapy.Current Opinion in Organ Transplantation 11/2007; 12(6):579-584. · 2.38 Impact Factor
- Revista medica de Chile 01/2009; 137(10). · 0.37 Impact Factor
- Arquivos de Gastroenterologia 01/2008; 45(4).