Perioperative effects of high doses of intraoperative thymoglobulin induction in liver transplantation  

作　　者：Lesley De Pietri Valentina Serra Giuseppe Preziosi Gianluca Rompianesi Bruno Begliomini 

机构地区：[1]Division of Anaesthesiology and Intensive Care Unit,Azienda Ospedaliero-Universitaria di Modena-Policlinico [2]Liver and Multivisceral Transplant Centre,Azienda Ospedaliero-Universitaria di Modena-Policlinico [3]Division of General Surgery,University College London

出　　处：《World Journal of Transplantation》2015年第4期320-328,共9页世界移植杂志

摘　　要：AIM:To describe our single-centre experience in liver transplantation(LT)with the infusion of high perioperative thymoglobulin doses.The optimal dosage and timing of thymoglobulin[antithymocyte globulin(ATG)]administration during LT remains controversial.Cytokine release syndrome,haemolytic anaemia,thrombocytopenia,neutropenia,fever and serum sickness are potential adverse effects associated with ATG infusion.METHODS:Between December 2009 and December 2010,16 adult non-randomized patients(ATG group),receiving a liver graft from a deceased donor,received an intraoperative infusion(4-6 h infusion)of thymoglobulin(3 mg/kg,ATG:Thymoglobuline).These patients were compared(case control approach)with 16 patients who had a liver transplant without ATG treatment(control group)to evaluate the possible effects of intraoperative ATG infusion.The matching parameters were:Sex,recipient age(±5 years),LT indication including viral status,MELD score(±5 points),international normalized ratio and platelet count(as close as possible).The exclusion criteria for both groups included the following:Multi-organ or living donor transplant,immunosuppressive therapy before transplantation,contraindications to the administration of any thymocyte globulin,human immunodeficiency virus seropositivity,thrombocytopenia[platelet<50000/μL]or leukopenia[white blood cells<1000/μL].The perioperative side effects(haemodynamic alterations,core temperature variations,colloids and crystalloids requirements,and surgical time)possibly related to ATG infusion and the thromboelastographic(TEG)evaluation of the ATG effects on coagulation,blood loss and blood product transfusion were analysed during the operation and the first three postoperative days.RESULTS:Intraoperative ATG administration was associated with longer surgical procedures[560±88 min vs 480±83 min(control group),P=0.013],an intraoperative core temperature more than 37℃(50%of ATG patients vs 6.2%of control patients,P=0.015),major intraoperative blood loss[3953±3126 mL vs 1419±940 mL(con

关 键 词：IMMUNOSUPPRESSION INDUCTION Cytokine release THYMOGLOBULIN THROMBOELASTOGRAPHY Liver TRANSPLANT 

分 类 号：R[医药卫生]