Perioperative effects of high doses of intraoperative thymoglobulin induction in liver transplantation

Table 1 Preoperative recipient characteristics

Characteristics		ATG group	Control group	P
Gender	Male	12 (75%)	15 (93.8%)	0.33
	Female	4 (25%)	1 (6.2%)
Age	yr	59.8 ± 8.3	55.9 ± 8.8	0.08
Cause of liver disease	Viral cirrhosis	10 (56.3%)	10 (56.3%)	1
	Alcoholic	4 (25%)	4 (25%)
	Cholestatic	1 (6.3%)	1 (6.3%)
	Hemochromatosis	1 (6.3%)	1 (6.3%)
HCV	Pos	7 (43.8%)	6 (37.5%)	1
HBV	Pos	4 (25%)	3 (18.8%)	1
HCC	Yes	6 (37.5%)	7 (43.8%)	1
MELD score		11.6 ± 6.5	11.6 ± 4.6	0.95
INR		1.29 ± 0.34	1.44 ± 0.59	0.57
PLT	103/μL	97.2 ± 50	94.1 ± 37.1	0.3

All parameters are matched 1:1 when possible. HCV: Hepatitis C virus; HBV: Hepatitis B virus; HCC: Hepatocellular carcinoma; MELD: Model for end stage liver disease; INR: International normalized ratio; PLT: Platelets; ATG: Antithymocyte globulin.

Table 2 Intraoperative parameters concerning transfusions, acid-base balance, fluids (colloids and crystalloids) and vasopressors administered in the two study groups

Intraoperative parameters recorded	ATG group	Control group	P
No. of patients transfused with RBC	16 (100%)	7 (43.8%)	0.01
Intraoperative blood loss (mL)	3953 ± 3126	1419 ± 940	0.05
Omologous blood transfused (mL)	2092 ± 1856	472 ± 632	0.02
Crystalloids (mL)	11356 ± 4419	6771 ± 2416	0.008
PLT transfused (g)	374 ± 537	15.6 ± 62.5	0.017
FFP transfused (g)	671 ± 1125	143 ± 349	0.015
No. of patients transfused with PLT	8 (50%)	1 (6.2%)	0.015
No. of patients transfused with FFP	9 (56.2%)	3 (18.8%)	0.07
No. of patients with core temperature > 37 °C	8 (50%)	1 (6.2%)	0.015
No. of patients who received Noradrenaline before reperfusion	11 (68.8%)	3 (18.8%)	0.013
Mean dosage of noradrenaline infused before reperfusion (μg/kg per minute)	0.08 ± 0.07	0.01 ± 0.38	0.03
Mean dosage of noradrenaline infused after reperfusion (μg/kg per minute)	0.2 ± 0.07	0.10 ± 0.11	0.029
No. of patients who received noradrenaline before and after reperfusion	11 (68.8%)	3 (18.8%)	0.013
Mean dosage of adrenaline infused at reperfusion (g)	106 ± 86	28 ± 21	0.047
pH before reperfusion	7.29 ± 0.85	7.36 ± 0.5	0.01
BE before reperfusion	-7.74 ± 4	-4.7 ± 2.6	0.005
pH after reperfusion	7.24 ± 0.7	7.3 ± 0.5	0.03
BE after reperfusion	-8.7 ± 3.2	-6.5 ± 2.4	0.02

Only statistically significant data are expressed. RBC: Red blood cell; FFP: Fresh frozen plasma; PLT: Platelets; BE: Base excess; ATG: Antithymocyte globulin.

Table 3 Haemodynamic variable measurements made in both groups during the different phases of liver transplantation and on post-op days 1 and 2

Phases of liver transplantation and post-op days 1 and 2	Groups	MAP		CI		SVRI		RVEDVI
		mmHg	P	L/min per square meter	P	dyne/s/cm5 per square meter	P	mL/m2	P
Basal	ATG	75 ± 10	0.18	5.1 ± 3.5	0.91	1100 ± 215	0.31	219 ± 75	0.12
	Control	70 ± 8		4.9 ± 2.8		1150 ± 324		222 ± 58
Laparotomy	ATG	67 ± 24	0.16	5.7 ± 3.4	0.41	730 ± 337	< 0.01	259 ± 120	0.21
	Control	70 ± 31		5.8 ± 2		1235 ± 488		262 ± 98
Pre-anhepatic	ATG	52 ± 19	< 0.01	6.5 ± 2.9	0.3	540 ± 188	< 0.01	340 ± 99	0.65
	Control	69 ± 25		5.9 ± 3.1		1145 ± 338		300 ± 78
Anhepatic	ATG	68 ± 12	0.16	7.5 ± 3.6	0.69	598 ± 213	< 0.01	335 ± 98	0.61
	Control	73 ± 23		6.3 ± 3.9		988 ± 238		308 ± 115
30’ post-reperfusion	ATG	48 ± 24	0.04	7.1 ± 3.1	0.7	510 ± 343	< 0.05	368 ± 75	0.63
	Control	59 ± 31		6.6 ± 3.8		855 ± 417		355 ± 58
60’ post-reperfusion	ATG	47 ± 33	< 0.01	7.2 ± 4.1	0.61	521 ± 243	< 0.001	300 ± 100	0.78
	Control	66 ± 28		6.6 ± 3.8		945 ± 301		289 ± 125
120’ post-reperfusion	ATG	55 ± 38	0.07	7.6 ± 4.3	0.04	788 ± 306	0.06	345 ± 107	0.005
	Control	65 ± 23		5.9 ± 3.8		1100 ± 398		268 ± 99
POD1	ATG	60 ± 32	< 0.05	6.8 ± 4.1	0.51	795 ± 341	0.01	305 ± 106	0.01
	Control	71 ± 40		6 ± 3.5		1100 ± 287		233 ± 102
POD2	ATG	67 ± 26	0.15	6.1 ± 2.5	0.43	1130 ± 438	< 0.08	238 ± 143	0.33

MAP: Mean arterial pressure; CI: Cardiac index; SVRI: Systemic vascular resistance index; RVEDVI: Right ventricle end-diastolic volume index; ATG: Antithymocyte globulin; POD: Postoperative day.

Table 4 Thromboelastographic values during the different phases of liver transplantation in the two study groups

	Measurements available for comparison of TEG variables (ATG vs control)	Groups		P
		ATG	Control
R basal (min)	16 vs 16	17.7 ± 9.6	29.9 ± 20.5	0.059
K basal (min)	16 vs 16	9.7 ± 3.39	18.7 ± 11.7	0.007
α basal (degrees)	16 vs 16	25 ± 9.8	16.2 ± 10.2	0.02
MA basal (mm)	16 vs 16	41.7 ± 8.8	40.2 ± 12.7	0.06
MA laparotomy (mm)	14 vs 16	31.5 ± 20.4	49.2 ± 11.4	0.002
R pre-anhepatic (min)	16 vs 16	41.4 ± 49.4	15.9 ± 6.0	0.017
α pre-anhepatic (degrees)	13 vs 16	12.4 ± 13.8	25.9 ± 11.5	0.007
MA pre-anhepatic (mm)	13 vs 16	21.2 ± 19	42.2 ± 12.7	0.002
R anhepatic (min)	16 vs 16	79.6 ± 117.7	14.7 ± 4.1	0.02
K anhepatic (min)	6 vs 16	4.6 ± 8.3	9 ± 3.5	0.01
α anhepatic (degrees)	13 vs 16	11.9 ± 14.4	26.0 ± 8.5	0.017
MA anhepatic (mm)	13 vs 16	17.7 ± 19.8	41.5 ± 9.5	0.004
K 30’ post-reperfusion (min)	8 vs 15	3.8 ± 6.3	8.0 ± 3.3	0.012
MA 30’ post-reperfusion (mm)	15 vs 16	20.4 ± 17.8	40.0 ± 8.9	0.003
K 60’ post-reperfusion (min)	9 vs 16	5.3 ± 6.7	9.1 ± 2.2	0.05
MA 60’ post-reperfusion (mm)	15 vs 16	24.1 ± 16.8	41.7 ± 6.2	0.02
MA 120’ post-reperfusion (mm)	16 vs 16	25.3 ± 12.4	40.4 ± 8.7	0.008

The differences between the ATG and control groups are shown as P-values. ATG: Antithymocyte globulin; TEG: Thromboelastographic; R: Reation time; K:Kinetics; MA: Maximum amplitude.

Table 5 Postoperative variables and the number of patients transfused with blood components in the postoperative period in the two study groups

Parameters	ATG group			Control group			P
	POD1	POD2	POD3	POD1	POD2	POD3	P1	P2	P3
Maximum core temperature (°C)	38 ± 1.0	37.3 ± 0.77	37 ± 0.43	37.3 ± 0.5	37.1 ± 0.48	37.0 ± 0.62	0.02	0.4	1
Creatinine (mg/dL)	1.13 ± 0.56	1.22 ± 0.68	1.52 ± 1.02	0.77 ± 0.14	0.81 ± 0.8	0.96 ± 0.55	0.03	0.6	0.7
WBC (103×μL)	6.9 ± 2.9	8.2 ± 2.7	8.2 ± 3.4	10.9 ± 3.6	12.6 ± 6.5	12.3 ± 6.3	0.01	0.009	0.9
PLT (103×μL)	37 ± 15	38 ± 18	22 ± 8	72 ± 37	60 ± 31	35 ± 19	0.001	0.01	0.02
HCT (%)	26.3 ± 5.6	27.3 ± 4.2	25.7 ± 3.1	32.4 ± 6.3	30.3 ± 7.6	28.5 ± 3.9	0.02	0.1	0.1
aPTT	1.8 ± 0.67	1.5 ± 0.29	1.2 ± 0.16	1.5 ± 0.49	1.3 ± 0.27	1.3 ± 0.19	0.04	0.33	0.46
Fibrinogen (mg/dL)	135 ± 40	171 ± 44	195 ± 73	193 ± 82	216 ± 76	239 ± 88	0.007	0.1	0.1
No. of patients who received noradrenaline	7 (43.7%)	4 (25%)	2 (12.5%)	1 (6.25%)	0	0	0.037	0.1	0.48
No. of patients transfused with RBC	6 (37.5%)	8 (50%)	1 (6.25%)	2 (12.5%)	2 (12.5%)	0	0.22	0.06	1
No. of patients transfused with PLT	5 (31.2%)	5 (31.2%)	4 (25%)	0	0	0	0.04	0.04	0.1
No. of patients transfused with FFP	5 (31.2%)	3 (18.7%)	0	1 (6.25%)	1 (6.25%)	0	0.17	0.6	NA
Albumin administered (mL)	243 ± 156	200 ± 164	161 ± 253	78 ± 140	135 ± 133	55 ± 88	0.014	0.23	0.1

WBC: White blood cells; PLT: Platelets; HCT: Haematocrit; aPTT: Activated partial thromboplastin time; RBC: Red blood cell; FFP: Fresh frozen plasma; POD: Postoperative day.