gms | German Medical Science

129. Kongress der Deutschen Gesellschaft für Chirurgie

Deutsche Gesellschaft für Chirurgie

24.04. - 27.04.2012, Berlin

Perioperative transfusion requirements and graft survival in patients with pancreas retransplantation – a retrospective study

Meeting Abstract

  • Jan M. Fertmann - Kliníkum der Universität München - Grosshadern, Chirurgische Klinik und Poliklinik, München
  • Helmut P. Arbogast - Kliníkum der Universität München - Grosshadern, Chirurgische Klinik und Poliklinik, München
  • Karl-Walter Jauch - Kliníkum der Universität München - Grosshadern, Chirurgische Klinik und Poliklinik, München
  • Johannes Hoffmann - Kliníkum der Universität München - Grosshadern, Chirurgische Klinik und Poliklinik, München

Deutsche Gesellschaft für Chirurgie. 129. Kongress der Deutschen Gesellschaft für Chirurgie. Berlin, 24.-27.04.2012. Düsseldorf: German Medical Science GMS Publishing House; 2012. Doc12dgch157

DOI: 10.3205/12dgch157, URN: urn:nbn:de:0183-12dgch1570

Veröffentlicht: 23. April 2012

© 2012 Fertmann et al.
Dieser Artikel ist ein Open Access-Artikel und steht unter den Creative Commons Lizenzbedingungen (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.de). Er darf vervielfältigt, verbreitet und öffentlich zugänglich gemacht werden, vorausgesetzt dass Autor und Quelle genannt werden.


Gliederung

Text

Introduction: Blood transfusion has been characterised as a negative predictive factor for graft and patient survival in liver transplantation. Pancreas retransplantation is sometimes technically challenging due to retroperitoneal adhesions and iliac arteries compromised by arteriosclerosis, and can be related to increased transfusion requirements. This retrospective study evaluates the long-term results of perioperative blood transfusions on allograft survival after pancreas retransplantation.

Material and methods: Between 1994 and 2005, 31 consecutive patients received pancreas retransplantation. Patients were retrospectively divided in two groups: One group included patients receiving <4 erythrocyte concentrates (ECs) perioperatively (n=18), the other patients receiving ≥4 ECs (n=13). Daily blood sampling was performed during 5 postoperative days. Groups were compared in terms of demographic parameters, postoperative laboratory changes, and graft survival.

Results: Demographic and preoperative laboratory parameters did not discriminate between groups. There was a tendency towards reduced release of lipase in patients receiving ≥4 ECs. Hemoglobin levels, aPTT and INRs were not statistically different between groups. From 18 patients receiving less ≤4 ECs, n=7 (33%) could be managed without perioperative ECs whereas the mean number of ECs applied was 1.3±1.2. Hemoglobin levels remained stable about 10g/dl in both groups over 5d. Graft survival was significantly reduced in the ECs ≥4 group with a median survival time of 479.3d versus 915.8d in the ECs <4 group. The reduction in graft survival in patients receiving ≥4 ECs was significant.

Conclusion: Increased necessity of perioperative blood transfusion is related to decreased graft survival in pancreas retransplantation. It is difficult to analyse whether increased transfusion requirements reflect a higher rate of bleeding in high-risk patients, or whether EC transfusion directly interferes with graft survival. Potential risks include transfusion-induced sepsis, immunologic pathways (soluble HLA’s) and transfusion-related acute lung injury. Therefore, a more restricted use of perioperative blood transfusions may be advocated as well as the use of autologous blood transfusion