Impact of early reoperation on graft survival after liver transplantation: Univariate and multivariate analysis

Elsabbagh, Ahmed; Girlanda, Raffaele; Hawksworth, Jason; Pichert, Matthew D.; Williams, Cassie; Pozzi, Agostino; Kroemer, Alexander; Nookala, Anupama; Smith, Coleman I.; Matsumoto, Cal; Fishbein, Thomas M.

doi:10.1111/ctr.13228

Cited by 10 publications

(8 citation statements)

References 27 publications

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“…The incidence of relaparotomy following LDLT ranges from 9.2% to 34%. The relatively high incidence of early relaparotomy is also related to increasing graft failure and mortality 7 8. In our center, the incidence of early relaparotomy was 23.8%, which is comparable to the range of relaparotomy in other centers.…”

Section: Discussionsupporting

confidence: 75%

Early relaparotomy following pediatric living-donor liver transplantation: experience in an Indonesian national referral hospital

Rahayatri

Soeratman

Amin

et al. 2023

World Jnl Ped Surgery

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BackgroundLiving donor liver transplantation (LDLT) remains the only curative treatment for children with end-stage liver disease; however, complications of the procedure are associated with indications for early relaparotomy. Several risk factors associated with early relaparotomy after liver transplantation include pediatric end-stage liver disease (PELD) score, warm ischemia time (WIT), and cold ischemia time (CIT). Our study investigated the incidence and indications of early relaparotomy in postoperative pediatric LDLT recipients and compared the outcomes with patients who did not require relaparotomy.MethodsA retrospective cohort study of pediatric LDLT recipients from Cipto Mangunkusumo Hospital, Jakarta, Indonesia, was collected from 2010 to August 2022. Indications for early relaparotomy were investigated. Factors analyzed in the early relaparotomy group compared with the nonrelaparotomy group included intraoperative blood loss, surgery duration, CIT, WIT, and PELD score.ResultsThe highest indication for early relaparotomy was biliary leakage. Most patients who underwent early relaparotomy only had one incidence of relaparotomy (60%). The surgery duration in subjects with early relaparotomy was longer by a median of 3 hours compared with those without early relaparotomy (p=0.289). Intraoperative blood loss was greater in early relaparotomy subjects than in subjects without early relaparotomy (95 vs 77 mL/kg, p=0.552). Other factors, such as PELD score, CIT, and WIT, also showed no significant difference between the two groups.ConclusionBiliary leakage was the most common indication for early relaparotomy in our center. There were no preoperative or intraoperative factors that significantly influenced the incidence of early relaparotomy due to the limited sample size and the early advancement of our liver transplant center.

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Section: Discussionsupporting

confidence: 75%

Early relaparotomy following pediatric living-donor liver transplantation: experience in an Indonesian national referral hospital

Rahayatri

Soeratman

Amin

et al. 2023

World Jnl Ped Surgery

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“…Eleven patients died within POD 30. The median MELD score of these patients was 29 . During the postoperative course, 45.4% (5/11) required at least one early relaparotomy.…”

Section: Resultsmentioning

confidence: 98%

“…Within the first year after LT, additional relaparotomies were required just in 6 cases, establishing an overall 1 year reoperation rate of 28.6%. Overall, the median length of hospital stay was 18 days . The median follow‐up after hospital discharge was 25.4 months [5.7–70.7].…”

Section: Resultsmentioning

confidence: 99%

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Early post‐liver transplant surgical morbidity inHIV‐infected recipients: risk factor for overall survival? A nationwide retrospective study

et al. 2019

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The aim of the study was to analyse the risk factors for early surgical complications requiring relaparotomy and the related impact on overall survival (OS) in HIV-infected patients submitted to liver transplantation. Thus a retrospective investigation was conducted on a nationwide multicentre cohort of 157 HIV patients submitted to liver transplantation in six Italian Transplant Units between 2004 and 2014. An early relaparotomy was performed in 24.8% of cases and the underlying clinical causes were biliary leak (8.2%), bleeding (8.2%), intestinal perforation (4.5%) and suspect of vascular complications(3.8%). No differences in terms of prevalence for either overall or cause-specific early relaparotomies were noted when compared with a non-HIV control group, matched for MELD, recipient age, HCV-RNA positivity and HBV prevalence. While in the control group an early relaparotomy appeared a negative prognostic factor, such impact on OS was not noted in HIV recipients. Nonetheless increasing number of relaparotomies were associated with decreased survival. In multivariate analysis, preoperative refractory ascites and Roux-en-Y choledochojejunostomy reconstruction were significant risk factors for early relaparotomy. To conclude, in HIV liver transplanted patients, an increasing number of early relaparotomies because of surgical complications does negatively affect the OS. Preoperative refractory ascites reflecting a severe portal hypertension and a difficult biliary tract reconstruction requiring a Roux-en-Y choledochojejunostomy are associated with increased risk of early relaparotomy.

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“…Dai et al [122] have recently identified complications grade IIIA or more according to Clavien-Dindo classification as only independent predictor of poor overall outcome (HR = 1.108; 95% CI 1.45-34.71; P = 0.015) in a series of 99 LT patients with HCC. Just recently, a study from Washington DC demonstrated in a series of 428 patients that re-operation following LT was an independent predictor of graft loss (OR = 5.125; 95%CI 1.35819.552; P = 0.016) [123] .…”

Section: Perioperative Complicationsmentioning

confidence: 99%

Liver transplantation for hepatocellular carcinoma - non-cancer factors and implications for improving outcome beyond standard tumor criteria

Kornberg¹,

Schernhammer²

2018

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How to cite this article: Kornberg A, Schernhammer M. Liver transplantation for hepatocellular carcinoma -non-cancer factors and implications for improving outcome beyond standard tumor criteria. Hepatoma Res 2018;4:60. http://dx. AbstractLiver transplantation (LT) is recognized as best treatment option in patients with early hepatocellular cancer (HCC) in underlying liver cirrhosis. Apart from tumor size and number implemented in the Milan criteria, which are current worldwide standards for patient selection, several biological tumor factors have been identified to affect cancer-specific outcome. In particular, grading and vascular tumor invasions were shown to correlate with aggressive biological tumor behavior and poor survival following LT. Identifying tumors with favorable biology is one important approach for expanding the pool of eligible liver recipients beyond the Milan burden limits. Improving the immunological state and condition for appropriate defense against circulating cancer cell attack may be another important prognostic aspect. Therefore, there is increasing interest in non-cancer factors related to the peritransplant period that may influence the oncological outcome by providing negative immunomodulatory actions. Considering and modulation of these non-HCC factors of prognosis might contribute in safely expanding the HCC LT selection criteria.

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Impact of early reoperation on graft survival after liver transplantation: Univariate and multivariate analysis

Abstract: This analysis demonstrates that early reoperations later than a week appear to negatively impact the graft survival. The timing of early reoperation should be a focus of additional studies.

Cited by 10 publications

References 27 publications

Early relaparotomy following pediatric living-donor liver transplantation: experience in an Indonesian national referral hospital

Early relaparotomy following pediatric living-donor liver transplantation: experience in an Indonesian national referral hospital

Early post‐liver transplant surgical morbidity inHIV‐infected recipients: risk factor for overall survival? A nationwide retrospective study

Liver transplantation for hepatocellular carcinoma - non-cancer factors and implications for improving outcome beyond standard tumor criteria

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