Fatores de risco para sangramento no perioperatório de transplante hepático

Abstract

Introduction: Liver transplantation is a highly complex surgical procedure indicated for patients with advanced chronic liver disease, acute liver failure and liver tumors when there is no alternative curative treatment. Complications of liver transplantation can arise soon after anesthetic induction, during the hepatectomy and graft implantation phases, or during an early and late post-transplant period. Bleeding is the most common complication in the trans and early postoperative period, having several related factors associated with high rates of morbidity and mortality of recipients. Objective: This study aims to assess risk factors for perioperative bleeding in liver transplantation. Method: This is a descriptive, retrospective study with a quantitative approach, analyzing 301 patients undergoing liver transplantation from a deceased donor from 2016 to 2020. Results: The sample comprised 207 (69%) males and 94 (31%) females. The mean age of patients at transplantation was 54 ± 12 years, with a median of 56 years. Among the age group, 192 (64%) patients were younger than 60, while 109 (36%) were 60 or older. Blood group O was predominant (55%), followed by group A (33%), B (9%) and AB (3%). The mean Body Mass Index was 27.1 ± 5.1 kg/m², with a median of 26.4 kg/m². Most patients (75%) had a BMI < 30 kg/m², 23% had a BMI between 30-40 kg/m² and 1.3% had a BMI > 40 kg/m². Among the factors that we evaluated preoperatively, high MELD score, decompensated cirrhosis, anaemia and portal thrombosis were those associated with a higher rate of bleeding. Among the variables of the MELD calculation, the INR and creatinine values were significantly higher in the group that presented bleeding (p<0.001). As for the CHILD-Pugh score, 136 (45%) were classified as CHILD C, followed by 128 (43%) CHILD B and only 37 (12%) CHILD A. The values of laboratory results of haemoglobin, hematocrit and INR were significantly relevant at all operative times (p< 0.001). In the perioperative period, total surgery time and cold ischemia time had higher impact rates on bleeding. We found portal thrombosis diagnosed preoperatively in 62 (21%) cases. 46 (74%) were partial, and 16 (26%) were total. As an incidental intraoperative finding, we found 25 cases of portal thrombosis (8.3%). The most common comorbidities, such as arterial hypertension and diabetes, previous surgery in the upper abdomen and anticoagulants in the preoperative period, had no impact on bleeding. Conclusion: Calculated MELD score greater than or equal to 25, decompensated cirrhosis (Child B/C), haemoglobin levels less than 10.01g/dL, prolonged cold ischemia time and portal thrombosis were the main factors associated with a higher rate of bleeding.