Intraoperative blood transfusion requirement is the main determinant of early surgical re-intervention after orthotopic liver transplantation

Abstract

Fax: +31-50-3613763 - re-intervention after orthotopic liver transplantationAbstract Liver transplantation is the treatment of choice in selected patients with end-stage liver disease. Postoperative complications often require surgical re-intervention. This study is a retrospective single-centre study to assess the incidence and type of surgical re-intervention during the in-hospital period after liver transplantation and to identify predictors of this re-intervention. From 1994 to 2002, 231 consecutive adult liver transplantations were performed. Re-intervention was classified as biliary, vascular, bleeding, septicaemia, re-transplantation or as miscellaneous. One hundred and thirty-nine surgical re-interventions were performed in 79 of 231 patients (34%). Septicaemia (44%) and 'bleeding (27%) were the most frequent indications for re-intervention, followed by biliary (10%) reintervention. Vascular re-intervention, re-transplantation, and reintervention for miscellaneous reasons, were performed in 7% each. Of all analysed variables (gender, age, diagnosis, acute liver failure, ChildPugh classification, Karnofsky score, previous abdominal surgery, creatinine clearance, prothrombin time, anti-thrombin, platelet count, surgical technique, cold ischaemia time, warm ischaemia time, functional anhepatic time, anatomic anhepatic time, revascularisation time, year of transplantation, aprotinin administration, transfused platelet concentrate, and red blood cell transfusion requirements), only the number of transfused red blood cell concentrates (RBCs) was identified as a predictor of surgical re-intervention. Median RBC transfusion requirement during liver transplantation was 2.9 1 (range 0-18.8 1) in the re-intervention group compared with 1.5 1 (range 0-13.4 1) in the non-re-intervention group (P < 0.001). This study revealed intraoperative blood loss as the main determinant of early surgical re-intervention after liver transplantation and emphasises the need for further attempts to control blood loss during liver transplantation.

Reoperative Complications after Primary Orthotopic Liver Transplantation: A Contemporary Single-Center Experience in the Post–Model for End-Stage Liver Disease Era

“…Similar to earlier reports, 10,20 intraoperative transfusion requirement was the most important predictor of reoperative complications after OLT, with other important predictors, including recipient factors (pretransplantation mechanical ventilation, earlier major abdominal operation), donor quality (donor LOS, serum sodium), and operative factors (CIT, WIT). Although it might be impossible to modify each factor individually, recipientedonor matching might allow collective modification of the overall risk of reoperative complications.…”

“…Data on posteliver transplantation complications specifically requiring reoperation are scarce, with few studies reporting on pre-MELD era cohorts 4,9,10 or limited by sample size. [11][12][13] Although many large series have reported the overall rates of postoperative graft nonfunction; vascular thromboses; and biliary, infectious, and hemorrhagic complications, 5,11,12,[14][15][16][17][18][19] neither the specific management nor the effects of these complications on graft and patient survival are described.…”

“…The literature has shown that a large intraoperative transfusion requirement is an important determinant of reoperative intervention and mortality. 10,20,21 A major objective of this study was to evaluate the association of reoperative complications with posttransplantation outcomes. The number of reoperations affected graft and patient survival considerably, with inferior 1-, 3-, and 5-year graft and patient survival rates in recipients with multiple reoperative complications compared with recipients with a single or no reoperative complication.…”

“…4,5 Although the general surgery literature indicates that relaparotomy increases mortality, 6-8 data about reoperative complications after OLT are limited. Few series in the literature report reoperative complication rates ranging from 34% to 44% in the pre-MELD era 9,10 and 17% to 26% in the post-MELD era. 11 The effect of reoperation on patient and graft survival is not reported, and the perioperative factors that contribute to complications requiring reoperation are unknown.…”

Use of higher thromboelastogram transfusion values is not associated with greater blood loss in liver transplant surgery

“…2 Other outcome studies have shown that intraoperative transfusions of plasma products significantly reduce 1-year survival [3][4][5] and increase morbidity in liver transplant recipients. 6 Physicians have used the thromboelastogram (TEG) as a tool for identifying abnormal coagulation. TEG can discriminate between different phases of the coagulation system and is, therefore, useful for identifying clotting abnormalities and guiding the administration of blood products.…”