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Volume: 11 Issue: 6 December 2013 - Supplement - 2

FULL TEXT

POSTER PRESENTATION
Transfusion-Related Acute Lung Injury (Trali) After Orthotopic Liver Transplantation (Olt): Report of 3 Cases

Introduction: TRALI is known as the leading cause of transfusion-related mortality that occurs within 6 h of transfusion and is defined as acute hypoxemia (PaO2/FIO2 <300 mmHg), bilateral pulmonary infiltrates on chest radiograph and no evidence of left atrial hypertension. The majority of patients recover within 72 to 96 h but some patients may remain hypoxic with persistent pulmonary infiltrates up to 7 days.

Case Reports: They were 3 cases of cirrhosis that OLT from deceased donor was performed for them between May 2011 and December 2012. The patients had no significant pulmonary complications before operation. They had difficult hepatic dissection besides massive bleeding intraoperative, so received massive transfusion [under guide of thromboelastography (TEG)] and had long operation time, therefore were sent intubated to intensive care unit (ICU). Postoperative, they suffered from respiratory distress, hypoxemia, agitation and bilateral infiltration on chest radiograph while transesophageal echocardiograghy (TEE) showed normal cardiac function in the patients. However, they were inevitably under low tidal volume assist/control mechanical ventilation for a few days. No-1: A 35 year-old man, known case of HBV cirrhosis that received 30 units packed red blood cells (PRBCs), 20 units fresh frozen plasma (FFP) and 10 units platelets intraoperative. After operation he was under mechanical ventilation for 6 days and weaned successfully. Control chest radiograph showed a little plural effusion and finally patient discharged with good condition on 22th day postoperative. No-2: A 44 year-old obese man with a body mass index (BMI) of 35 kg/m2 and cryptogenic cirrhosis that received 15 units PRBCs, 5 units FFP, 5 units platelets and 2 g fibrinogen concentrate during OLT . Postoperative, he was under mechanical ventilation for 3 days and had a successful weaning and normal control chest X-ray. He had a progressive rehabilitation till 20th day that was afflicted by pulmonary thromboembolism so we started medical treatment plus mechanical ventilation for him, but he expired on 24th day postoperative. No-3: A 55 year-old man with cryptogenic cirrhosis that received 10 units PRBCs, 6 units FFP, 4 units platelets and 3 g fibrinogen concentrate intraoperative. After transplantation he was under mechanical ventilation and simultaneous suffered from renal insufficiency and mild coagolopathy, but he was weaned successfully on 4th day and then stayed in the department and discharged with good condition on 25th day.

Conclusions: Blood transfusion has remained a critical feature in OLT and TRALI is the dominant and serious hazard of transfusion. It seems necessary to Improve prevention methods for transfusion like TEG besides continued effort toward recognition and prevention of complication associated with blood components administration especially TRALI.



Volume : 11
Issue : 6
Pages : 59


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