|
|
|
题名
|
作者
|
年代
|
出处
|
被引量
|
| 1 | Perioperative thromboprophylaxis in liver transplant patients显示文摘Improvements in surgical and anesthetic procedures have increased patient survival after liver transplantation(LT). However, the perioperative period of LT can still be affected by several complications. Among these, thromboembolic complications(intracardiac thrombosis, pulmonary embolism, hepatic artery and portal vein thrombosis) are relatively common causes of increased morbidity and mortality. The benefit of thromboprophylaxis in general surgical patients has already been established, but it is not the standard of care in LT recipients. LT is associated with a high bleeding risk, as it is performed in a setting of already unstable hemostasis. For this reason, the role of routine perioperative prophylactic anticoagulation is usually restricted. However, recent data have shown that the bleeding tendency of cirrhotic patients is not an expression of an acquired bleeding disorder but rather of coexisting factors(portal hypertension, hypervolemia and infections). Furthermore, in cirrhotic patients, the new paradigm of ‘‘rebalanced hemostasis' ' can easily tip towards hypercoagulability because of the recently described enhanced thrombin generation, procoagulant changes in fibrin structure and platelet hyperreactivity. This new coagulation balance, along with improvements in surgical techniques and critical support, has led to a dramatic reduction in transfusion requirements, and the intraoperative thromboembolic-favoring factors(venous stasis, vessels clamping, surgical injury) have increased the awareness of thrombotic complications and led clinicians to reconsider the limited use of anticoagulants or antiplatelets in the postoperative period of LT. | Lesley De Pietri Roberto Montalti Daniele Nicolini Roberto Ivan Troisi Federico Moccheggiani Marco Vivarelli | 2018 | World Journal of Gastroenterology2018，24，27： | 9 |
| 2 | Intraoperative thromboelastography as a tool to predict postoperative thrombosis during liver transplantation显示文摘BACKGROUND Thromboembolic complications are relatively common causes of increased morbidity and mortality in the perioperative period in liver transplant patients.Early postoperative portal vein thrombosis(PVT,incidence 2%-2.6%)and early hepatic artery thrombosis(HAT,incidence 3%-5%)have a poor prognosis in transplant patients,having impacts on graft and patient survival.In the present study,we attempted to identify the predictive factors of these complications for early detection and therefore monitor more closely the patients most at risk of thrombotic complications.AIM To investigate whether intraoperative thromboelastography(TEG)is useful in detecting the risk of early postoperative HAT and PVT in patients undergoing liver transplantation(LT).METHODS We retrospectively collected thromboelastographic traces,in addition to known risk factors(cold ischemic time,intraoperative requirement for red blood cells and fresh-frozen plasma transfusion,prolonged operating time),in 27 patients,selected among 530 patients(≥18 years old),who underwent their first LT from January 2002 to January 2015 at the Liver University Transplant Center and developed an early PVT or HAT(case group).Analyses of the TEG traces were performed before anesthesia and 120 min after reperfusion.We retrospectively compared these patients with the same number of nonconsecutive control patients who underwent LT in the same study period without developing these complications(1:1 match)(control group).The chosen matching parameters were:Patient graft and donor characteristics[age,sex,body mass index(BMI)],indication for transplantation,procedure details,United Network for Organ Sharing classification,BMI,warm ischemia time(WIT),cold ischemia time(CIT),the volume of blood products transfused,and conventional laboratory coagulation analysis.Normally distributed continuous data are reported as the mean±SD and compared using one-way Analysis of Variance(ANOVA).Nonnormally distributed continuous data are reported as the median(interquartile range)and compared using the Mann-Whitney test.Categorical variables were analyzed with Chi-square tests with Yates correction or Fisher’s exact test depending on best applicability.IBM SPSS Statistics version 24(SPSS Inc.,Chicago,IL,United States)was employed for statistical analysis.Statistical significance was set at P<0.05.RESULTS Postoperative thrombotic events were identified as early if they occurred within 21 d postoperatively.The incidence of early hepatic artery occlusion was 3.02%,whereas the incidence of PVT was 2.07%.A comparison between the case and control groups showed some differences in the duration of surgery,which was longer in the case group(P=0.032),whereas transfusion of blood products,red blood cells,fresh frozen plasma,and platelets,was similar between the two study groups.Thromboelastographic parameters did not show any statistically significant difference between the two groups,except for the G value measured at basal and 120’postreperfusion time.It was higher,although within the reference range,in the case group than in the control group(P=0.001 and P<0.001,respectively).In addition,clot lysis at 60 min(LY60)measured at 120’postreperfusion time was lower in the case group than in the control group(P=0.035).This parameter is representative of a fibrinolysis shutdown(LY60=0%-0.80%)in 85%of patients who experienced a thrombotic complication,resulting in a statistical correlation with HAT and PVT.CONCLUSION The end of surgery LY60 and G value may identify those recipients at greater risk of developing early HAT or PVT,suggesting that they may benefit from intense surveillance and eventually anticoagulation prophylaxis in order to prevent these serious complications after LT. | Lesley De Pietri Roberto Montalti Giuliano Bolondi Valentina Serra Fabrizio Di Benedetto | 2020 | World Journal of Transplantation2020，10，11： | 5 |
| 3 | Predictive factors of short term outcome after liver transplantation: A review显示文摘Liver transplantation represents a fundamental therapeutic solution to end-stage liver disease. The need for liver allografts has extended the set of criteria for organ acceptability, increasing the risk of adverse outcomes. Little is known about the early postoperative parameters that can be used as valid predictive indices for early graft function, retransplantation or surgical reintervention, secondary complications, long intensive care unit stay or death. In this review, we present state-of-the-art knowledge regarding the early posttransplantation tests and scores that can be applied during the first postoperative week to predict liver allograft function and patient outcome, thereby guiding the therapeutic and surgical decisions of the medical staff. Post-transplant clinical and biochemical assessment of patients through laboratory tests(platelet count, transaminase and bilirubin levels, INR, factor V, lactates, and Insulin Growth Factor 1) and scores(model for end-stage liver disease, acute physiology and chronic health evaluation, sequential organ failure assessment and model of early allograft function have been reported to have good performance, but they only allow late evaluation of patient status and graft function, requiring days to be quantified. The indocyanine green plasma disappearance rate has long been used as a liver function assessment technique and has produced interesting, although not univocal, results when performed between the 1th and the 5th day after transplantation. The liver maximal function capacity test is a promising method of metabolic liver activity assessment, but its use is limited by economic cost and extrahepatic factors. To date, a consensual definition of early allograft dysfunction and the integration and validation of the above-mentioned techniques, through the development of numerically consistent multicentric prospective randomised trials, are necessary. The medical and surgical management of transplanted patients could be greatly improved by using clinically reliable tools to predict early graft function. | Giuliano Bolondi Federico Mocchegiani Roberto Montalti Daniele Nicolini Marco Vivarelli Lesley De Pietri | 2016 | World Journal of Gastroenterology2016，22，26： | 5 |
| 4 | Thromboelastographic reference ranges for a cirrhotic patient population undergoing liver transplantation显示文摘AIM To describe the thromboelastography(TEG) 'reference' values within a population of liver transplant(LT) candidates that underline the differences from healthy patients.METHODS Between 2000 and 2013, 261 liver transplant patients with a model for end-stage liver disease(MELD) score between 15 and 40 were studied. In particular the adult patients(aged 18-70 years) underwent to a first LT with a MELD score between 15 and 40 were included, while all patients with acute liver failure, congenital bleeding disorders, and anticoagulant and/or antiplatelet drug use were excluded. In this population of cirrhotic patients, preoperative haematological and coagulation laboratory tests were collected, and the pretransplant thromboelastographic parameters were studied and compared with the parameters measured in a previously studied population of 40 healthy subjects. The basal TEG parameters analysed in the cirrhotic population of liver candidates were as follows: Reaction time(r), coagulation time(k), Angle-Rate of polymerization of clot(α Angle), Maximum strenght of clot(MA), Amplitudes of the TEG tracing at 30 min and 60 min after MA is measured(A30 and A60), and Fibrinolysis at 30 and 60 min after MA(Ly30 and Ly60). The possible correlation between the distribution of the reference range and the gender, age, MELD score(higher or lower than 20) and indications for transplantation(liver pathology) were also investigated. In particular, a MELD cut-off value of 20 was chosen to verify the possible correlation between the thromboelastographic reference range and MELD score. RESULTS Most of the TEG reference values from patients with end-stage liver disease were significantly different from those measured in the healthy population and were outside the suggested normal ranges in up to 79.3% of subjects. Wide differences were found among all TEG variables, including r(41.5% of the values), k(48.6%), α(43.7%), MA(79.3%), A30(74.4%) and A60(80.9%), indicating a prevailing trend to hypocoagulability. The differences between the mean TEG values obtained from healthy subjects and the cirrhotic population were statistically significant for r(P = 0.039), k(P < 0.001), MA(P < 0.001), A30(P < 0.001), A60(P < 0.001) and Ly60(P = 0.038), indicating slower and less stable clot formation in the cirrhotic patients. In the cirrhotic population, 9.5% of patients had an r value shorter than normal, indicating a tendency for faster clot formation. Within the cirrhotic patient population, gender, age and the presence of hepatocellular carcinoma or alcoholic cirrhosis were not significantly associated with greater clot firmness or enhanced whole blood clot formation, whereas greater clot strength was associated with a MELD score < 20, hepatitis C virus and cholestaticrelated cirrhosis(P < 0.001; P = 0.013; P < 0.001).CONCLUSION The range and distribution of TEG values in cirrhotic patients differ from those of healthy subjects, suggesting that a specific thromboelastographic reference range is required for liver transplant candidates. | Lesley De Pietri Marcello Bianchini Gianluca Rompianesi Elisabetta Bertellini Bruno Begliomini | 2016 | World Journal of Transplantation2016，6，3： | 4 |
| 5 | Ochratoxin A in grape and wine显示文摘 | Battilani P Pietri A | 2002 | European Journal of Plant Pathology2002，108，： | 1 |
| 6 | Cardioprotective and antioxidant effects of the terpenoid constituents of Ginkgo biloba extract ( Egb761 ) 显示文摘 | Pietri S Maurelli E Drieu K | 1997 | J Mol Cell cardiol1997，29，2： | 1 |
| 7 | Inflam marion and arterial hypertension: from pathophysiological links to risk prediction显示文摘 | PIETRI P VLACHOPOULOS C TOUSOUI3S D | 2015 | Curr Med Chem2015，22，23： | 1 |
| 8 | Cardioprotective and anti-oxidant effects of the terpenoid constituents of Ginkgo biloba extract (Egb761)显示文摘 | Pietris Maurelli E Drienk | 1997 | J Mol Cell Cardiol1997，29，2： | 1 |
| 9 | Low-back pain in commercial travelers显示文摘 | Pietri F Leclerc A Boitel L | 1992 | Scandinavian Journalof Work Environment & Health1992，18，1： | 1 |
| 10 | Activated carbons:in vitro affinity for ochratoxin A and deoxynivalenol and relation of adsorption ability to physicochemical parameters显示文摘 | GALVANO F PIETRI A BERTUZZI T | 1998 | Journal of Food Protection1998，61，4： | 1 |
| 11 | Throm-boelastographic changes in liver and pancreatic cancer surgery: hy-percoagulability ,hypocoagulability or normocoagulability? 显示文摘 | DE PIETRI L MONTALTI R BEGUOMINI B | 2010 | Eur J Anaesthesiol2010，27，7： | 1 |
| 12 | Nitrogen mineralisation along a pH gradient of a silty loam UK soil显示文摘 | Pietri J C A Brookes P C | 2008 | Soil Biology and Biochem istry2008，40，3： | 1 |
| 13 | Maternal dietary habits and mycotoxin occurrence in human mature milk 显示文摘 | GALVANO F PIETRI A BERTUZZI T | 2008 | Mol Nutr Food Res2008，52，4： | 1 |
| 14 | Improved control of mealtime glucose excursions with coadministration of nateglinide and metformin显示文摘 | Hirschberg Y Karara AH Pietri AO | 2000 | Diabetes Care2000，23，3： | 1 |
| 15 | Aflatoxins and ochratoxin A in dried chestnuts and chestnut flour produced in Italy显示文摘 | Amedeo Pietri Silvia Rastelli Annalisa Mulazzi Terenzio Bertuzzi | 2011 | Food Control2011，，2： | 1 |
| 16 | Relationships between soil pH and microbial properties in a UK arable soil显示文摘 | ACIEGO PIETRI J C BROOKES P C | 2008 | Soil Biology and Biochemistry2008，40，： | 1 |
| 17 | Relationship between low-grade inflammation and arterial stiffness in patients with essential hypertension显示文摘 | Pietri P Vyssoulis G Vtaehopoulos C | 2006 | J Hypertens2006，24，11： | 1 |
| 18 | PME- 1 protects extracellular signal-regulated kinase pathway activity t-rom protein phosphatase 2A-mediated inactivation in human malignant glioma 显示文摘 | Pietri P Melissa R J Sari V | 2009 | Cancer Res2009，69，： | 1 |
| 19 | Ginkgo biloba extract (Egb) pretreatment limits free radical-induced oxidative stress in patients undergoing coronary bypass surgery显示文摘 | Pietri S Seguin JR d'Arbigny P | 1997 | Cardiovasc Drugs Ther1997，11，2： | 1 |
| 20 | Ascorbyl free radical:a noninvasivemarker of oxidative stress in human open-heart surgery显示文摘 | Pietri S Sequin JR Darbigny P | 1994 | Free Rad BioMed1994，16，： | 1 |
您所在的机构暂未开通此部分的功能，请联系管理员