Effects of preoperative plasma exchange therapy with albumin replacement fluid on blood coagulation in patients undergoing ABO-incompatible living-donor kidney transplantation using rotational thromboelastometry

Kazuhiro Shirozu, Naoyuki Fujimura, Yuji Karashima, Mizuko Ikeda, Hidehisa Kitada, Yasuhiro Okabe, Kei Kurihara, Henzan Tomoko, Sumio Hoka

研究成果: ジャーナルへの寄稿記事

抄録

Background: ABO-incompatible living-donor kidney transplantation (LDKT) requires immunotherapy and plasma exchange therapy (PEX). PEX with albumin replacement fluid reportedly decreases fibrinogen levels. However, no reports have described the effects of PEX with albumin replacement fluid on blood coagulation parameters and blood loss during the perioperative period. Therefore, we investigated the effects of preoperative PEX on blood coagulation parameters and blood loss during the perioperative period in patients undergoing ABO-incompatible LDKT as measured by rotational thromboelastometry (ROTEM®). Methods: Twenty-eight patients undergoing LDKT were divided into the PEX group (ABO incompatible with PEX, n = 13) and non-PEX group (ABO compatible without PEX, n = 15). ROTEM® parameters, standard laboratory test parameters, bleeding volume, and transfusion volume were compared between PEX and non-PEX group. MCE platelet , which represents platelet contribution to clot strength and where "MCE" stands for maximum clot elasticity, was calculated from the difference in MCE between EXTEM and FIBTEM. Results: The bleeding volume during surgery and the intensive care unit (ICU) stay was significantly higher in the PEX than non-PEX group (p < 0.01). Maximum clot firmness (MCF) of EXTEM (MCF EXTEM ), MCF FIBTEM , and MCE platelet was significantly lower in the PEX than non-PEX group (p < 0.01). In the PEX group, the bleeding volume during surgery was very strongly correlated with the baseline MCF EXTEM and MCE platelet , and the bleeding volume during the ICU stay was strongly correlated with the postoperative MCF EXTEM and MCE platelet . Conclusions: These results suggest that the increased blood loss in the PEX group during surgery and the ICU stay was associated with decreased platelet contribution to clot strength as measured by ROTEM®. Trial registration: UMIN-Clinical Trial Registry UMIN000018355. Registered 21 July 2015.

元の言語英語
記事番号68
ジャーナルBMC anesthesiology
18
発行部数1
DOI
出版物ステータス出版済み - 6 19 2018

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Thrombelastography
Plasma Exchange
Living Donors
Blood Coagulation
Kidney Transplantation
Albumins
Group Psychotherapy
Blood Platelets
Therapeutics
Hemorrhage
Intensive Care Units
Perioperative Period
Elasticity
Immunotherapy
Fibrinogen
Registries

All Science Journal Classification (ASJC) codes

  • Anesthesiology and Pain Medicine

これを引用

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title = "Effects of preoperative plasma exchange therapy with albumin replacement fluid on blood coagulation in patients undergoing ABO-incompatible living-donor kidney transplantation using rotational thromboelastometry",
abstract = "Background: ABO-incompatible living-donor kidney transplantation (LDKT) requires immunotherapy and plasma exchange therapy (PEX). PEX with albumin replacement fluid reportedly decreases fibrinogen levels. However, no reports have described the effects of PEX with albumin replacement fluid on blood coagulation parameters and blood loss during the perioperative period. Therefore, we investigated the effects of preoperative PEX on blood coagulation parameters and blood loss during the perioperative period in patients undergoing ABO-incompatible LDKT as measured by rotational thromboelastometry (ROTEM{\circledR}). Methods: Twenty-eight patients undergoing LDKT were divided into the PEX group (ABO incompatible with PEX, n = 13) and non-PEX group (ABO compatible without PEX, n = 15). ROTEM{\circledR} parameters, standard laboratory test parameters, bleeding volume, and transfusion volume were compared between PEX and non-PEX group. MCE platelet , which represents platelet contribution to clot strength and where {"}MCE{"} stands for maximum clot elasticity, was calculated from the difference in MCE between EXTEM and FIBTEM. Results: The bleeding volume during surgery and the intensive care unit (ICU) stay was significantly higher in the PEX than non-PEX group (p < 0.01). Maximum clot firmness (MCF) of EXTEM (MCF EXTEM ), MCF FIBTEM , and MCE platelet was significantly lower in the PEX than non-PEX group (p < 0.01). In the PEX group, the bleeding volume during surgery was very strongly correlated with the baseline MCF EXTEM and MCE platelet , and the bleeding volume during the ICU stay was strongly correlated with the postoperative MCF EXTEM and MCE platelet . Conclusions: These results suggest that the increased blood loss in the PEX group during surgery and the ICU stay was associated with decreased platelet contribution to clot strength as measured by ROTEM{\circledR}. Trial registration: UMIN-Clinical Trial Registry UMIN000018355. Registered 21 July 2015.",
author = "Kazuhiro Shirozu and Naoyuki Fujimura and Yuji Karashima and Mizuko Ikeda and Hidehisa Kitada and Yasuhiro Okabe and Kei Kurihara and Henzan Tomoko and Sumio Hoka",
year = "2018",
month = "6",
day = "19",
doi = "10.1186/s12871-018-0536-2",
language = "English",
volume = "18",
journal = "BMC Anesthesiology",
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TY - JOUR

T1 - Effects of preoperative plasma exchange therapy with albumin replacement fluid on blood coagulation in patients undergoing ABO-incompatible living-donor kidney transplantation using rotational thromboelastometry

AU - Shirozu, Kazuhiro

AU - Fujimura, Naoyuki

AU - Karashima, Yuji

AU - Ikeda, Mizuko

AU - Kitada, Hidehisa

AU - Okabe, Yasuhiro

AU - Kurihara, Kei

AU - Tomoko, Henzan

AU - Hoka, Sumio

PY - 2018/6/19

Y1 - 2018/6/19

N2 - Background: ABO-incompatible living-donor kidney transplantation (LDKT) requires immunotherapy and plasma exchange therapy (PEX). PEX with albumin replacement fluid reportedly decreases fibrinogen levels. However, no reports have described the effects of PEX with albumin replacement fluid on blood coagulation parameters and blood loss during the perioperative period. Therefore, we investigated the effects of preoperative PEX on blood coagulation parameters and blood loss during the perioperative period in patients undergoing ABO-incompatible LDKT as measured by rotational thromboelastometry (ROTEM®). Methods: Twenty-eight patients undergoing LDKT were divided into the PEX group (ABO incompatible with PEX, n = 13) and non-PEX group (ABO compatible without PEX, n = 15). ROTEM® parameters, standard laboratory test parameters, bleeding volume, and transfusion volume were compared between PEX and non-PEX group. MCE platelet , which represents platelet contribution to clot strength and where "MCE" stands for maximum clot elasticity, was calculated from the difference in MCE between EXTEM and FIBTEM. Results: The bleeding volume during surgery and the intensive care unit (ICU) stay was significantly higher in the PEX than non-PEX group (p < 0.01). Maximum clot firmness (MCF) of EXTEM (MCF EXTEM ), MCF FIBTEM , and MCE platelet was significantly lower in the PEX than non-PEX group (p < 0.01). In the PEX group, the bleeding volume during surgery was very strongly correlated with the baseline MCF EXTEM and MCE platelet , and the bleeding volume during the ICU stay was strongly correlated with the postoperative MCF EXTEM and MCE platelet . Conclusions: These results suggest that the increased blood loss in the PEX group during surgery and the ICU stay was associated with decreased platelet contribution to clot strength as measured by ROTEM®. Trial registration: UMIN-Clinical Trial Registry UMIN000018355. Registered 21 July 2015.

AB - Background: ABO-incompatible living-donor kidney transplantation (LDKT) requires immunotherapy and plasma exchange therapy (PEX). PEX with albumin replacement fluid reportedly decreases fibrinogen levels. However, no reports have described the effects of PEX with albumin replacement fluid on blood coagulation parameters and blood loss during the perioperative period. Therefore, we investigated the effects of preoperative PEX on blood coagulation parameters and blood loss during the perioperative period in patients undergoing ABO-incompatible LDKT as measured by rotational thromboelastometry (ROTEM®). Methods: Twenty-eight patients undergoing LDKT were divided into the PEX group (ABO incompatible with PEX, n = 13) and non-PEX group (ABO compatible without PEX, n = 15). ROTEM® parameters, standard laboratory test parameters, bleeding volume, and transfusion volume were compared between PEX and non-PEX group. MCE platelet , which represents platelet contribution to clot strength and where "MCE" stands for maximum clot elasticity, was calculated from the difference in MCE between EXTEM and FIBTEM. Results: The bleeding volume during surgery and the intensive care unit (ICU) stay was significantly higher in the PEX than non-PEX group (p < 0.01). Maximum clot firmness (MCF) of EXTEM (MCF EXTEM ), MCF FIBTEM , and MCE platelet was significantly lower in the PEX than non-PEX group (p < 0.01). In the PEX group, the bleeding volume during surgery was very strongly correlated with the baseline MCF EXTEM and MCE platelet , and the bleeding volume during the ICU stay was strongly correlated with the postoperative MCF EXTEM and MCE platelet . Conclusions: These results suggest that the increased blood loss in the PEX group during surgery and the ICU stay was associated with decreased platelet contribution to clot strength as measured by ROTEM®. Trial registration: UMIN-Clinical Trial Registry UMIN000018355. Registered 21 July 2015.

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U2 - 10.1186/s12871-018-0536-2

DO - 10.1186/s12871-018-0536-2

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