Surgical complications after living and deceased donor liver transplant: The NSQIP transplant experience

Abstract

This study used the prospective National Surgical Quality Improvement Program (NSQIP) Transplant pilot database to analyze surgical complications after liver transplantation (LT) in LT recipients from 2017to 2019. The primary outcome was surgical complication requiring intervention (Clavien-Dindo grade II or greater) within 90 days of transplant. Of the 1684 deceased donor and 109 living donor LT cases included from 29 centers, 38% of deceased donor liver recipients and 47% of living donor liver recipients experienced a complication. The most common complications included biliary complications (19% DDLT; 31% LDLT), hemorrhage requiring reoperation (14% DDLT; 9% LDLT), and vascular complications (6% DDLT; 9% LDLT). Management of biliary leaks (35.3% ERCP, 38.0% percutaneous drainage, 26.3% reoperation) and vascular complications (36.2% angioplasty/stenting, 31.2% medication, 29.8% reoperation) was variable. Biliary (aHR 5.14, 95% CI 2.69-9.8, P < .001), hemorrhage (aHR 2.54, 95% CI 1.13-5.7, P = .024) and vascular (aHR 2.88, 95% CI .85-9.7, P = .089) complication status at 30-days post-transplant were associated with lower 1-year patient survival. We conclude that biliary, hemorrhagic and vascular complications continue to be significant sources of morbidity and mortality for LT recipients. Understanding the different risk factors for complications between deceased and living donor liver recipients and standardizing complication management represent avenues for continued improvement.

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“…Infant liver transplantation has improved greatly in the last 40 years. 1 , 2 This success is due to advances in surgical techniques, superior organ preservation methods, availability of more effective immunosuppressive agents, and broad accumulating worldwide experience. 3 …”

“…Infant liver transplantation has improved greatly in the last 40 years. 1,2 This success is due to advances in surgical techniques, superior organ preservation methods, availability of more effective immunosuppressive agents, and broad accumulating worldwide experience. 3 Liver transplantation involves three moments: pre-, trans-, and post-transplantation, all with a multidisciplinary team working to ensure minimal complications throughout the process.…”