Differential Effects of Plasma and Red Blood Cell Transfusions on Acute Lung Injury and Infection Risk Following Liver Transplantation

被引:127
作者
Benson, Alexander B. [1 ]
Burton, James R., Jr. [2 ]
Austin, Gregory L. [2 ]
Biggins, Scott W. [2 ]
Zimmerman, Michael A. [3 ]
Kam, Igal [3 ]
Mandell, Susan [4 ]
Silliman, Christopher C. [5 ]
Rosen, Hugo [2 ]
Moss, Marc [1 ]
机构
[1] Univ Colorado Denver, Div Pulm Sci & Crit Care, Aurora, CO USA
[2] Univ Colorado Denver, Div Gastroenterol & Hepatol, Aurora, CO USA
[3] Univ Colorado Denver, Dept Transplant Surg, Aurora, CO USA
[4] Univ Colorado Denver, Dept Anesthesia, Aurora, CO USA
[5] Bonfils Blood Ctr, Denver, CO USA
关键词
CENTRAL VENOUS-PRESSURE; BACTERIAL-INFECTIONS; CARDIAC-SURGERY; NOSOCOMIAL INFECTIONS; MASSIVE TRANSFUSION; ANTIBIOTIC-PROPHYLAXIS; PRODUCT REQUIREMENTS; PULMONARY-EDEMA; CDC DEFINITIONS; SURVIVAL;
D O I
10.1002/lt.22212
中图分类号
R57 [消化系及腹部疾病];
学科分类号
摘要
Patients with chronic liver disease have an increased risk of developing transfusion-related acute lung injury (TRALI) from plasma-containing blood products. Similarly, red blood cell transfusions have been associated with postoperative and nosocomial infections in surgical and critical care populations. Patients undergoing liver transplantation receive large amounts of cellular and plasma-containing blood components, but it is presently unclear which blood components are associated with these postoperative complications. A retrospective cohort study of 525 consecutive liver transplant patients revealed a perioperative TRALI rate of 1.3% (7/525, 95% confidence interval = 0.6%-2.7%), which was associated with increases in the hospital mortality rate [28.6% (2/7) versus 2.9% (15/518), P = 0.02] and the intensive care unit length of stay [2(1-11 days) versus 0 days (0-2 days), P = 0.03]. Only high-plasma-containing blood products (plasma and platelets) were associated with the development of TRALI. Seventy-four of 525 patients (14.1%) developed a postoperative infection, and this was also associated with increased in-hospital mortality [10.8% (8/74) versus 2.0% (9/451), P < 0.01] and a prolonged length of stay. Multivariate logistic regression determined that the number of transfused red blood cell units (adjusted odds ratio = 1.08, 95% confidence interval = 1.02-1.14, P < 0.01), the presence of perioperative renal dysfunction, and reoperation were significantly associated with postoperative infection. In conclusion, patients undergoing liver transplantation have a high risk of developing postoperative complications from blood transfusion. Plasma-containing blood products were associated with the development of TRALI, whereas red blood cells were associated with the development of postoperative infections in a dose-dependent manner. Liver Transpl 17:149-158, 2011. (C) 2011 AASLD,
引用
收藏
页码:149 / 158
页数:10
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