既往心胸外科术后肺移植围手术期出血的风险

IF 1.9 4区医学 Q2 SURGERY

Clinical Transplantation Pub Date : 2025-04-17 DOI:10.1111/ctr.70151

Bryan Chow, Morgan A. Rosser, Jacob A. Klapper, Negmeldeen Mamoun, Matthew G. Hartwig, Kevin A. Wu, Jessica L. Poisson, Katherine Young, Kamrouz Ghadimi, Ian J. Welsby, Brandi A. Bottiger

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引用次数: 0

摘要

既往心胸外科手术（CTS）与肺移植（LT）围手术期出血的显著风险相关。先前手术的类型还没有明确定义。我们的目的是根据以前的CTS病史量化肝移植围手术期出血的风险。方法：我们对接受双侧肝移植的成年患者进行了回顾性研究，并将受体分层为无既往CTS （no -CTS）、微创CTS （Mi-CTS）或开放/侵入性CTS （I-CTS）。主要结局是出现严重/大出血或更严重的围手术期出血（UDPB）的修改通用定义。多变量分析以p值<；0.05为差异有统计学意义。结果共纳入507例患者。I-CTS发生严重/大出血的几率高出3.93 (95% CI [1.98-7.98]；p & lt;0.001)，出血更严重的几率比No-CTS高4.37 (95% CI [2.27-8.70]；p & lt;0.001)。I-CTS出血加重的几率比Mi-CTS高2.38 (95% CI [1.14-5.11]；P = 0.023)。与No-CTS相比，Mi-CTS发生严重/大出血和更严重出血的风险更高。结论既往CTS侵袭性越强，围手术期出血风险越高，预后越差。更有侵入性的先前手术预示着出血的风险，需要更多的输血和医院资源。各中心应检查术前优化、术中管理和术中体外生命支持（ECLS）策略的机会，以减轻这种风险。

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Perioperative Bleeding Risk in Lung Transplantation After Previous Cardiothoracic Surgery

Introduction

Previous cardiothoracic surgery (CTS) is associated with a significant risk of perioperative bleeding in lung transplantation (LT). The types of prior surgery have not been well-defined. We aimed to quantify the risk of perioperative bleeding in LT based on a history of previous CTS.

Methods

We conducted a retrospective study of adult patients who underwent bilateral LT and stratified recipients into no prior CTS (No-CTS), minimally invasive CTS (Mi-CTS), or open/invasive CTS (I-CTS). The primary outcome was the occurrence of severe/massive bleeding or worse bleeding by the modified universal definition of perioperative bleeding (UDPB). Multivariable analysis was performed with p value <0.05 for statistical significance.

Results

507 recipients were included. I-CTS had 3.93 higher odds of severe/massive bleeding (95% CI [1.98–7.98]; p < 0.001) and 4.37 higher odds of worse bleeding than No-CTS (95% CI [2.27–8.70]; p < 0.001). I-CTS had 2.38 higher odds of worse bleeding than Mi-CTS (95% CI [1.14–5.11]; p = 0.023). Mi-CTS had a higher risk of severe/massive bleeding and worse bleeding than No-CTS.

Conclusion

Patients with more invasive prior CTS had an increased risk of perioperative bleeding and worse outcomes. More invasive previous surgery predicts bleeding risk and requires more transfusion and hospital resources. Centers should examine opportunities for preoperative optimization, intraoperative management, and intraoperative extracorporeal life support (ECLS) strategies to mitigate this risk.

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来源期刊

Clinical Transplantation 医学-外科

CiteScore

3.70

自引率

4.80%

发文量

286

审稿时长

2 months

期刊介绍： Clinical Transplantation: The Journal of Clinical and Translational Research aims to serve as a channel of rapid communication for all those involved in the care of patients who require, or have had, organ or tissue transplants, including: kidney, intestine, liver, pancreas, islets, heart, heart valves, lung, bone marrow, cornea, skin, bone, and cartilage, viable or stored. Published monthly, Clinical Transplantation’s scope is focused on the complete spectrum of present transplant therapies, as well as also those that are experimental or may become possible in future. Topics include: Immunology and immunosuppression; Patient preparation; Social, ethical, and psychological issues; Complications, short- and long-term results; Artificial organs; Donation and preservation of organ and tissue; Translational studies; Advances in tissue typing; Updates on transplant pathology;. Clinical and translational studies are particularly welcome, as well as focused reviews. Full-length papers and short communications are invited. Clinical reviews are encouraged, as well as seminal papers in basic science which might lead to immediate clinical application. Prominence is regularly given to the results of cooperative surveys conducted by the organ and tissue transplant registries. Clinical Transplantation: The Journal of Clinical and Translational Research is essential reading for clinicians and researchers in the diverse field of transplantation: surgeons; clinical immunologists; cryobiologists; hematologists; gastroenterologists; hepatologists; pulmonologists; nephrologists; cardiologists; and endocrinologists. It will also be of interest to sociologists, psychologists, research workers, and to all health professionals whose combined efforts will improve the prognosis of transplant recipients.