Intraoperative Blood Loss Predicts Hemorrhage-Related Reoperation after Orthotopic Liver Transplantation

Kappa, Stephen F.; Gorden, D. Lee; Davidson, Mario; Wright, J. Kelly; Guillamondegui, Oscar D.

doi:10.1177/000313481007600931

Cited by 26 publications

(16 citation statements)

References 21 publications

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“…Although DC with intra-abdominal packing and temporary closure has gained popularity in the treatment of patients with multisystem trauma, 4,13,21,22 hepatic trauma, [23][24][25][26][27][28][29][30][31] and nontrauma, [5][6][7]32,33 few data exist regarding its use in liver transplant, with the literature limited to case reports and small case series. [34][35][36] This study is the largest contemporary singlecenter experience with DC in liver transplant. We report graft and patient outcomes and define predictors of the need for DC.…”

Section: Discussionmentioning

confidence: 99%

Damage Control as a Strategy to Manage Postreperfusion Hemodynamic Instability and Coagulopathy in Liver Transplant

et al. 2015

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Section: Discussionmentioning

confidence: 99%

Damage Control as a Strategy to Manage Postreperfusion Hemodynamic Instability and Coagulopathy in Liver Transplant

et al. 2015

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“…The reoperation rate after LT is reported to be high, ranging from 9.2% to 34% [10] – [13] , while the reoperation rate after liver resection is reported to be as low as 2.5% to 10.9% [14] – [16] . In fact, at our institute, reoperations were performed for only 3 cases (2.7%) among 111 corresponding donors for biliary leakage (2 cases, 1.8%) and postoperative bleeding (1 case, 0.9%).…”

Section: Discussionmentioning

confidence: 99%

“…Regarding risk factors for early reoperation, female sex, Child-Pugh class C, Non-HCV etiology, fulminant hepatitis, and the amount of intraoperative FFP administered were identified as possibly predictive variables, among which female sex and the amount of intraoperative FFP were identified as independent risk factors by multivariable analysis. Hendriks et al [10] and Kappa et al [13] reported that intraoperative blood loss predicted early reoperation. Child-Pugh class C and the amount of intraoperative FFP, which represent poor recipient liver function and have been associated with poor recipient outcome [24] , [25] , can reasonably be associated with early reoperation after liver transplantation, although, to the best of our knowledge, this is the first report demonstrating a higher early reoperation rate in more seriously ill recipients.…”

Section: Discussionmentioning

confidence: 99%

“…Despite improved graft and recipient survival, the reoperation rate among LT recipients remains high, ranging from 9.2% to 34% [10] – [13] , compared to that for liver resection, which ranges from 2.5% to 10.9% [14] – [16] . While several studies about the post-LT complication rates, including early reoperation, have been reported, there are few reports of the factors associated with early reoperation and the influence of early reoperation on LT recipient outcome.…”

Section: Introductionmentioning

confidence: 99%

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Impact of Early Reoperation following Living-Donor Liver Transplantation on Graft Survival

et al. 2014

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BackgroundThe reoperation rate remains high after liver transplantation and the impact of reoperation on graft and recipient outcome is unclear. The aim of our study is to evaluate the impact of early reoperation following living-donor liver transplantation (LDLT) on graft and recipient survival.MethodsRecipients that underwent LDLT (n = 111) at the University of Tokyo Hospital between January 2007 and December 2012 were divided into two groups, a reoperation group (n = 27) and a non-reoperation group (n = 84), and case-control study was conducted.ResultsEarly reoperation was performed in 27 recipients (24.3%). Mean time [standard deviation] from LDLT to reoperation was 10 [9.4] days. Female sex, Child-Pugh class C, Non-HCV etiology, fulminant hepatitis, and the amount of intraoperative fresh frozen plasma administered were identified as possibly predictive variables, among which females and the amount of FFP were identified as independent risk factors for early reoperation by multivariable analysis. The 3-, and 6- month graft survival rates were 88.9% (95%confidential intervals [CI], 70.7–96.4), and 85.2% (95%CI, 66.5–94.3), respectively, in the reoperation group (n = 27), and 95.2% (95%CI, 88.0–98.2), and 92.9% (95%CI, 85.0–96.8), respectively, in the non-reoperation group (n = 84) (the log-rank test, p = 0.31). The 12- and 36- month overall survival rates were 96.3% (95%CI, 77.9–99.5), and 88.3% (95%CI, 69.3–96.2), respectively, in the reoperation group, and 89.3% (95%CI, 80.7–94.3) and 88.0% (95%CI, 79.2–93.4), respectively, in the non-reoperation group (the log-rank test, p = 0.59).ConclusionsObserved graft survival for the recipients who underwent reoperation was lower compared to those who did not undergo reoperation, though the result was not significantly different. Recipient overall survival with reoperation was comparable to that without reoperation. The present findings enhance the importance of vigilant surveillance for postoperative complication and surgical rescue at an early postoperative stage in the LDLT setting.

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“…Similarly, liver transplantation may also cause excessive blood loss during surgery, which may lead to increased postoperative morbidity and mortality. 89 There are several approaches available to attempt to reduce intraoperative blood loss, as will be outlined below.…”

Section: Prevention and Treatment Of Bleedingmentioning

confidence: 99%

Hemostatic Complications in Hepatobiliary Surgery

Bos

Bernal

Porte

et al. 2017

Semin Thromb Hemost

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Hepatobiliary surgery is a well-known risk factor for thrombotic complications but is also associated with substantial perioperative blood loss. Given the central role of the liver in hemostasis, hepatobiliary surgery is frequently accompanied by complex changes in the hemostatic system. Increasing knowledge of these changes has resulted in an improved understanding of the etiology of some of the hemostatic complications. In the early postoperative period a prolongation of conventional coagulation test times, such as the prothrombin time, is frequently seen. Together with a decreased platelet count, this suggests a hypocoagulable state. The concomitant decline of anticoagulant factors and development of a von Willebrand factor/ADAMTS13 (a disintegrin and metalloproteinase with a thrombospondin type 1 motif, member 13) imbalance, however, suggest a hypercoagulable state, potentially contributing to the risk of thromboembolism. Postoperative thromboprophylaxis should be initiated early to avoid thrombosis, and intensified prophylaxis might benefit high-risk patients. The risk of hemorrhagic complications during hepatobiliary surgery has diminished over time, mainly due to improved surgical and anesthesiological techniques. However, bleeding can still be profound in individual patients and is difficult to predict using (global) hemostasis tests. A restrictive transfusion and fluid infusion policy to maintain a low central venous pressure is crucial in prevention of perioperative bleeding. However, when active bleeding occurs, proactive prohemostatic management is required.

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Intraoperative Blood Loss Predicts Hemorrhage-Related Reoperation after Orthotopic Liver Transplantation

Cited by 26 publications

References 21 publications

Damage Control as a Strategy to Manage Postreperfusion Hemodynamic Instability and Coagulopathy in Liver Transplant

Damage Control as a Strategy to Manage Postreperfusion Hemodynamic Instability and Coagulopathy in Liver Transplant

Impact of Early Reoperation following Living-Donor Liver Transplantation on Graft Survival

Hemostatic Complications in Hepatobiliary Surgery

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