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【Objective】 To establish a practical and feasible blood management (PBM) model for clinical liver transplant patients, so as to optimize the perioperative blood usage and improve patient prognosis and survival rate. 【Methods】 Led by the Medical Department, a questionnaire survey Establishment and Implementation of a Blood Management Model for Organ Transplant Patients on the importance of establishing a PBM model for liver transplant patients in clinical practice was conducted among 71 staff from relevant departments such as the Anesthesiology Department, Hepatobiliary Department, Blood Transfusion Department, and ICU Medical Department. After statistical analysis, the important items of PBM for liver transplant patients were determined, and a (trial) plan was organized by the Medical Department and training was conducted by Blood Transfusion Department for medical staff training from departments as Anesthesiology, Hepatobiliary and Pancreatology, and ICU; PBM measures for liver transplant patients before, during and after surgery were determined by the Anesthesiology Department, Hepatobiliary and Pancreatic Department, and ICU; PBM was fully implemented in the experimental group with liver transplant patients in our hospital in 2021 as subjects; 30 cases of liver transplantation performed in our hospital in 2020 were selected as the control group, and the general data, preoperative laboratory examination results, and preoperative, intraoperative, and postoperative blood transfusion of the two groups of patients were compared. 【Results】 Compared with the control group, the experimental group did not receive any blood component transfusion before surgery. Intraoperative blood transfusion volume of allogeneic components: red blood cells(U) were 12.75(8.75, 18.63) vs 15.25(8.38, 26.13)(P>0.05), apheresis platelet (treatment volume) was 0(0, 2) vs 1(0, 4.25)(P>0.05), plasma(U) was 2 300(1 550, 3 763) vs 3 650(2 075, 5 400)(P0.05), platelets were not transfused, plasma(U) was 0(0, 0) vs 0(0, 600)(P>0.05), and cryoprecipitates were not transfused. 【Conclusion】 The establishment of PBM model for liver transplant patients and the application of its management measures before, during and after transplantation significantly reduced the intraoperative blood transfusion volume and improved the prognosis of patients after transplantation.
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【Objective】 To provide references for clinical prediction of blood preparation and blood consumption, as well as the influencing factors of mass-transfusion by analyzing the perioperative blood transfusion in patients underwent heart transplantation. 【Methods】 The blood transfusions of 44 patients with heart transplantation completed in the Department of Cardiac Surgery of our hospital from March 2014 to January 2022 were retrospectively collected. Patient information included age, gender, preoperative diagnosis, relevant medical history, history of cardiac surgery, and history of antithrombotic medication. The risk factors of perioperative red blood cell transfusion in patients with heart transplantation were analyzed by univariate analysis method and multivariate logistic regression method. 【Results】 All 44(100%) heart transplant patients received blood components: the average transfusion units of red blood cells was 3.75(0, 7.5) U (72.73%), plasma 1 140 (597.5, 1782.5) mL (97.73%), cryoprecipitate 10(9.5±10) U(88.64%), platelets 1(1, 1.25) therapeutic amount (86.36%). The rate of massive transfusion of red blood cells was 45.45% (20/44). The univariate analysis found that there were significant differences in preoperative use of antithrombotic drugs, blood loss, and cardiopulmonary bypass time between the red blood cell transfusion group≤4 U (n=24) and the red blood cell transfusion group >4 U (n=20) (P<0.05). Multivariate Logistic regression analysis showed that preoperative antithrombotic drug treatment (n=15) was OR 5.900, 95%CI 1.313~26.521(P<0.05) and cardiopulmonary bypass time was OR 1.024, 95%CI 1.000~1.049(P<0.05). 【Conclusion】 The perioperative transfusion rate of blood components in cardiac transplant patients was high. The preoperative use of antithrombotic drugs, and prolonged cardiopulmonary bypass are risk factors for massive red blood cell transfusion.
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【Objective】 To explore the influencing factors of perioperative red blood cell transfusion in patients underwent lung transplantation, so as to provide reference for perioperative blood management (PBM) of lung transplantation patients. 【Methods】 The clinical data of 173 lung transplant patients completed in China-Japan Friendship Hospital from March 2017 to June 2019 were retrospectively analyzed. The patients were divided into two groups according to perioperative red blood cell transfusion volume: large blood transfusion group (transfusion red blood cell volume ≥6 U, n=66) and non-large blood transfusion group (red blood cell transfusion volume <6 U, n=107). The basic information, preoperative laboratory test results, and surgical status of the two groups were statistically analyzed.The clinical data of the two groups were analyzed by univariate analysis. The factors of P<0.15 were included in the binary logistic regression analysis, and the independent influencing factors of perioperative massive blood transfusion in patients with lung transplantation were found. 【Results】 Univariate analysis of clinical data of the two groups of patients (large blood transfusion group vs. non-large blood transfusion group) showed that the differences of smoking history ratio [44(66.7%) vs 87(81.3%)], BMI(20.8±4.5 vs 22.5±4.0)(P<0.05), preoperative Hb [124(111, 138.8) vs 138(126, 149)], preoperative Hct [37.9(34.8, 42.5) vs 41.3(37.9, 44.6)], surgery duration(327.9±107.7 vs 238.4±77.0), intraoperative blood loss(1 108.6±1342.0 vs 341.8±270.8) and single lung transplantation [28(42.4%) vs 84(78.5%)] (P<0.01) were statistically significant. Logistic regression analysis showed that intraoperative blood loss (OR=1.001, P<0.05), surgery duration (OR=1.006, P<0.05), preoperative Hb (OR=0.973, P<0.01), lung transplantation type(single or double lung transplantation)( OR=0.247, P<0.05) and extracorporeal membrane oxygenation (ECMO) (OR=0.187, P<0.01) were independent factors influencing red blood cell transfusion during lung transplantation. 【Conclusion】 Intraoperative blood loss and surgery duration are risk factors for massive blood transfusion during the perioperative period. And the use of ECMO, preoperative Hb, single lung transplantation (compared to double lung transplantation) are protective factors for perioperative massive blood transfusion.
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【Objective】 To explore the relationship between preoperative anemia and perioperative red blood cell (RBC) transfusion and postoperative outcomes in patients undergoing mitral valve surgery. 【Methods】 The clinical data, laboratory findings, blood transfused and outcomes data of 493 patients who underwent mitral valve surgery in Fuwai Hospital in 2017 were collected by blood transfusion management system and retrospectively analyzed by SPSS. The patients were divided into anemia group (n=34, male Hb<120 g/L and female Hb<110 g/L) and non-anemia group (n=459) .The measurement data were statistically analyzed with t test or rank sum test, and enumeration data by Fisher test and Chi-square test, and then all analyzed by binary logistics regression. 【Results】 The incidence of anemia before mitral valve surgery was 6.90% (34/493). Perioperative erythrocyte dosage (U) (median), erythrocyte transfusion rate, ICU stay time (d) (median) and hospital mortality rate(%) in anemia group and non-anemia group were 4.00 vs 0.00 (OR: 2.55, 95% CI: 1.70~3.40, P<0.05), 67.65% vs 21.35% (OR: 12.98, 95% Cl: 5.21~31.15, P<0.05), 2.50 vs 2.00 (B: 0.71, 95% Cl: 0.08~1.33, P<0.05) and 5.88 vs 0.22(P<0.05)respectively. 【Conclusion】 Preoperative anemic is independently associated with perioperative RBC transfusion in patients undergoing mitral valve surgery, and may increase ICU length of stay and hospital mortality.
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Objective To analyze the effect of perioperative blood transfusion in orthopedic surgery.Methods A total of 201 patients who underwent an orthopedic surgery in our hospital in October 2015 to September 2016 were reviewed.Hemoglobin concentrations,hematocrit,postoperative hospital stay,infection and other related data were analyzed.Results 90 patients were transfused with blood and in 111 patients were not during orthopedic surgery (massive blood transfusion group including 17 cases;non massive blood transfusion group including 94 cases).Hemoglobin concentrations of transfusion group (103.09±16.37)g/L was lower than the non transfusion group (115.79± 13.68)g/L before liying hospital,postoperative hospitalization time of transfusion group (12.012±8.36) was longer than that of non transfusion group (16.14 ± 10.47)days.Postoperative infection rate in non transfusion group was 1.11％,and in transfusion group was 15.32％,in massive transfusion group is 52.94％.Conclusion Perioperative blood transfusion is not conducive to the recovery of hemoglobin level patients in orthopedic surgery,prolong hospital stay and increase the rate of infection after surgery.Perioperative blood transfusion makes it difficult to support the outcome of the disease
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BACKGROUND/AIMS: In Korea about 70% of hepatocellular carcinoma(HCC) are associated with hepatitis B surface antigenemia. And hepatic resection is regarded as best treatment option for selected HCC patients. So we conducted this study to analyze the outcome and to identify the factors associated with outcome after hepatectomy for HBs Ag associated HCC. METHODS: We retrospectively analyzed the clinicopathological data of 104 HBs Ag associated HCC patients who underwent hepatic resection from Sep-1987 through Oct-1997 in KCCH. Median follow-up period was 21.5 month. Survival rates were estimated by Kaplan-Meier method and difference was detected by Log-rank test using SPSS program for Windows. Multivariate analysis was done using Cox regression hazard model. RESULTS: Overall 5 year survival rate was 62.9% and 5 year disease free survival rate was 42.2%. Factors which influence on survival were multiplicity, portal vein invasion, perioperative transfusion, tumor stage. Recurrence occurred in 42 cases and 33 cases developed intrahepatic recurrence. 3 year survival rate after recurrence was 34.7%. CONCLUSION: Hepatic resection plays a significant role for selected HBs Ag related HCC and tumor number, portal vein invasion, transfusion and TNM stage were statistically significant prognostic factors( p<0.05). So meticulous technique is required to avoid transfusion perioperatively. For the high risk patients, further study to reduce the recurrence should be followed.