Gerinnungsmanagement bei Lebertransplantationen

Zusammenfassung

Viele Patienten entwickeln im Rahmen einer Lebertransplantation Gerinnungsstörungen oder Blutungsprobleme. Andererseits kommt es bei einigen Patienten in der perioperativen Phase zu thromboembolischen Ereignissen mit z. T. fatalem Ausgang. Deshalb änderten wir 1999 unser Gerinnungsmanagement bei Lebertransplantationen und verließen die routinemäßige Prophylaxe mit Antifibrinolytika. In diesem Zusammenhang implementierten wir die ROTEM ®-Diagnostik (Pentapharm GmbH, München) im perioperativen Point-of-Care-Gerinnungsmanagement. In den Jahren 2000 bis 2005 wurden von uns mehr als 18 000 ROTEM-Messungen im Zusammenhang mit 642 Lebertransplantationen durchgeführt. Eine prophylaktische Gabe von Antifibrinolytika erfolgte nur bei Patienten mit fulminantem Leberversagen oder bei einer MCF im ExTEM ≤35 mm zu Beginn der Operation. Bei den übrigen Patienten wurde in 60% eine Hyperfibrinolyse intraoperativ nachgewiesen. Allerdings war eine Antifibrinolytikatherapie nur bei 40% der Patienten erforderlich. Unsere Erfahrungen haben wir in einem Algorithmus zum ROTEM-gesteuerten perioperativen Gerinnungsmanagement bei Lebertransplantationen zusammengefasst.

Summary

In the course of liver transplantation many patients develop coagulation and bleeding disorders. On the other hand, some patients suffer thromboembolic events in the perioperative period with sometimes fatal outcome. For this reason, in 1999 we changed our coagulation management for liver transplantation and abolished the routine prophylaxis with antifibrinolytic drugs. In this context we implemented the ROTEM system (Pentapharm GmbH, Munich) in our perioperative point-of-care coagulation management. From 2000 to 2005, we analysed more than 18 000 ROTEM measurements in the context of 642 liver transplantations. Prophylactic administration of antifibrinolytic drugs was only done in patients with fulminant liver failure or if MCF in ExTEM ≤35 mm at the beginning of surgery. In the other patients hyperfibrinolysis was detected in 60% during the operation. However, therapy with an antifibrinolytic drug only was necessary in 40% of the patients. Our experience is summarised in an algorithm for ROTEMbased perioperative coagulation management for liver transplantation.

Schlüsselwörter

Lebertransplantation - Point-of-Care-Gerinnungsmanagement - Rotationsthrombelastometrie - Hyperfibrinolyse

Keywords

Liver transplantation - point-of-care coagulation management - thrombelastometry - hyperfibrinolysis

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