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Blood loss during liver transplantation is a predictor of postoperative thrombosis

Rui An, Ruiping Bai, Simei Zhang, Peiling Xie, Yulin Zhu, Jian Wen, Qingyong Ma and Xin Shen
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DOI: https://doi.org/10.7861/clinmed.2021-0665
Clin Med September 2022
Rui An
AFirst Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
Roles: doctor
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Ruiping Bai
AFirst Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
Roles: doctor
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Simei Zhang
AFirst Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
Roles: doctor
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Peiling Xie
AFirst Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
Roles: doctor
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Yulin Zhu
BFirst Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
Roles: associate chief physician
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Jian Wen
BFirst Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
Roles: associate chief physician
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Qingyong Ma
CFirst Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
Roles: chief physician
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Xin Shen
CFirst Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
Roles: chief physician
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  • For correspondence: shenxin6125@mail.xjtu.edu.cn
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  • Fig 1.
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    Fig 1.

    Receiver operating characteristic curve for the ability of blood loss to discriminate between patients with and without postoperative thrombosis. AUC = area under the curve.

  • Fig 2.
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    Fig 2.

    Receiver operating characteristic curve for the multivariable prognostic model with the independent factors. AUC = area under the curve.

  • Fig 3.
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    Fig 3.

    Postoperative prognostic nomogram to predict the probability of postoperative thrombosis after liver transplantation.

  • Fig 4.
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    Fig 4.

    Calibration curve of the nomogram for the probability of postoperative thrombosis (bootstrap 1,000 repetitions). C-index = concordance index; CI = confidence interval.

  • Fig 5.
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    Fig 5.

    Receiver operating characteristic curves for predicting postoperative thrombosis. a) Primary cohort. b) Validation cohort. AUC = area under the curve; CI = confidence interval.

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    Table 1.

    Description of intraoperative blood loss during liver transplantation

    Total, n=232No thrombosis, n=206With thrombosis, n=26p-value
    Blood loss, mL/kg, median (IQR)16.9 (10.1–28.9)15.9 (9.8–27.9)32.8 (17.9–61.5)<0.001
    • IQR = interquartile range.

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    Table 2.

    Clinical and donor characteristics of all study patients for thrombosis groups

    Total, n=232No thrombosis, n=206With thrombosis, n=26p-value
    MELD score, median (IQR)15 (10–20)15 (10–19)18 (12–26.5)0.056
    Primary hepatic carcinoma, n (%)73 (31.5)69 (33.5)4 (15.4)0.061
    Hemoglobin, g/L, mean (SD)109.3 (24.4)111 (24)96.4 (23.9)0.007
    RBC count, × 1012/L, median (IQR)3.5 (3–4.1)3.5 (3.0–4.2)3.1 (2.6–3.5)0.017
    Haematocrit, %, median (IQR)32 (27.9–37.5)32.4 (28.2–38.1)28.3 (23.8–33)0.006
    PT, seconds, median (IQR)17.7 (15.7–20.9)17.6 (15.5–20.5)19.6 (17.1–27.8)0.004
    aPTT, seconds, median (IQR)44.8 (40.2–51.4)44.4 (39.9–50.4)48.3 (42.5–58.1)0.031
    INR, median (IQR)1.5 (1.3–1.8)1.5 (1.2–1.8)1.7 (1.4–2.6)0.004
    Fibrinogen, g/L, median (IQR)1.8 (1.5–2.4)1.8 (1.5–2.4)1.6 (1–2)0.008
    D-dimer, mg/L, median (IQR)1.8 (0.8–4.3)1.7 (0.7–4.1)3.6 (1.3–10.1)0.004
    • aPTT = activated partial thromboplastin time; INR = international normalised ratio; MELD = Model for End-stage Liver Disease; PT = prothrombin time; RBC = red blood cell.

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    Table 3.

    Operative factors associated with postoperative thrombosis

    Total, n = 232No thrombosis, n = 206With thrombosis, n = 26p-value
    Duration of surgery, hours, median (IQR)6 (5.5–7)6 (5.5–7)7 (6–8.8)0.003
    Anhepatic phase, minutes, median (IQR)50 (42–57)51 (45–60)51 (44–56)0.391
    HA anastomosis time, minutes, median (IQR)40 (35–45)40 (35–45)40 (40–55)0.096
    Intraoperative blood transfusion
    RBC, mL/kg, median (IQR)17.5 (8.1–26.2)16.5 (7.4–25.3)26 (18–40)0.001
    FFP, mL/kg, median (IQR)18.2 (12.2–26.7)16.7 (11.8–25.2)27.7 (17.3–38.4)<0.001
    Cryoprecipitate, units, median (IQR)5 (0–10)5 (0–10)10 (0–17)0.081
    • FFP = fresh frozen plasma; HA = hepatic artery; RBC = red blood cell.

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    Table 4.

    Multivariate analysis of postoperative thrombosis

    p-valueBSEWaldHR95% CI
    Total blood loss ≥31.25 mL/kg0.0121.6510.6576.3255.2141.440–18.884
    Haemoglobin, g/L0.013–0.1560.0636.1931.8561.757–1.967
    Haematocrit, %0.0350.5870.2794.4371.7991.042–3.107
    • B = beta coefficient; CI = confidence interval; HR = hazard ratio; SE = standard error.

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Blood loss during liver transplantation is a predictor of postoperative thrombosis
Rui An, Ruiping Bai, Simei Zhang, Peiling Xie, Yulin Zhu, Jian Wen, Qingyong Ma, Xin Shen
Clinical Medicine Sep 2022, 22 (5) 434-440; DOI: 10.7861/clinmed.2021-0665

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Blood loss during liver transplantation is a predictor of postoperative thrombosis
Rui An, Ruiping Bai, Simei Zhang, Peiling Xie, Yulin Zhu, Jian Wen, Qingyong Ma, Xin Shen
Clinical Medicine Sep 2022, 22 (5) 434-440; DOI: 10.7861/clinmed.2021-0665
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