Volume 10 Issue 3
May  2019
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Article Navigation >  ORGAN TRANSPLANTATION  > 2019  >  10(3): 323-327
Liu Huanye, Kou Jiantao, Ma Jun, et al. Experience in perioperative management of liver transplantation in hepatic coma patients[J]. ORGAN TRANSPLANTATION, 2019, 10(3): 323-327. doi: 10.3969/j.issn.1674-7445.2019.03.017
Citation: Liu Huanye, Kou Jiantao, Ma Jun, et al. Experience in perioperative management of liver transplantation in hepatic coma patients[J]. ORGAN TRANSPLANTATION, 2019, 10(3): 323-327. doi: 10.3969/j.issn.1674-7445.2019.03.017
shu

Experience in perioperative management of liver transplantation in hepatic coma patients

doi: 10.3969/j.issn.1674-7445.2019.03.017

  • Department of Hepatobiliary, Pancreatic and Splenic Surgery, Beijing Chaoyang Hospital affiliated to Capital Medical University, Beijing 100020, China

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    Abstract
  •   Objective  To analyse the clinical efficacy of liver transplantation and summarize the clinical experience of perioperative management in patients with hepatic coma.  Methods  Clinical data of 22 patients with hepatic coma undergoing liver transplantation were retrospectively analyzed. The perioperative conditions of the recipients were observed, including operation time, warm/cold ischemia time of donor liver, intraoperative anhepatic phase of the recipients, intraoperative blood loss, intraoperative blood transfusion, early postoperative blood drug concentration and incidence of postoperative complications. The survival situation of the recipients and the influencing factors of clinical prognosis were analyzed.  Results  The operation time of 22 recipients was 8 (6-12) h, the warm ischemia time of donor liver was 4 (2-6) min, the cold ischemia time was 7 (5-10) h, intraoperative anhepatic phase of recipients was 80 (55-120) min, intraoperative blood loss was 1 139 (400-4 000) mL and intraoperative blood transfusion was 1 440 (0-3 600) mL.The blood concentration of tacrolimus (FK506) fluctuated between 6 and 11 ng/mL at postoperative one week. Six recipients died after liver transplantation including 1 case of primary graft liver failure, 2 cases of severe infection, 1 case of severe cerebral edema caused by cerebral hemorrhage and 2 cases of multiple organ failure. The postoperative 1 month and 1 year survival rates of hepatic coma recipients were 82% and 77%.  Conclusions  Liver transplantation can significantly improve the survival rate of patients with hepatic coma. Preoperative decreasing blood ammonia, controlling postoperative infection, improving renal function and formulating precise individualized immunosuppression therapy according to immune status play a pivotal role in enhancing the survival rate.

     

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