Vascular Complications of Orthotopic Liver Transplantation: Experience in More than 4,200 Patients

Duffy, John P.; Hong, Johnny C.; Farmer, Douglas G.; Ghobrial, Rafik M.; Yersiz, Hasan; Hiatt, Jonathan R.; Busuttil, Ronald W.

doi:10.1016/j.jamcollsurg.2008.12.032

Cited by 453 publications

(494 citation statements)

References 26 publications

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“…[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. This study represents the largest contemporary singlecenter experience to report the scope of reoperative complications after primary liver transplantation and their associations with graft and patient outcomes.…”

Section: Discussionmentioning

confidence: 99%

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

DiNorcia

Lee

Harlander-Locke

et al. 2014

Journal of the American College of Surgeons

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BACKGROUND: Data on complications requiring reoperation after orthotopic liver transplantation (OLT) are limited. We sought to describe the spectrum of reoperative complications after OLT, evaluate the associations with graft and patient survival, and identify predictors of need for reoperation. STUDY DESIGN: We retrospectively studied adult patients who underwent primary OLT at our institution from February 2002 to July 2012. The primary outcomes included occurrence of a reoperative complication. Secondary outcomes were graft and patient survival. Multivariable logistic regression analysis was used to model the associations of recipient, donor, and operative variables with reoperation.

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Section: Discussionmentioning

confidence: 99%

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

DiNorcia

Lee

Harlander-Locke

et al. 2014

Journal of the American College of Surgeons

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“…Although HAT is more common in the pediatric population, 16 it has been reported to complicate 3% to 5% of adult orthotopic LT procedures. [16][17][18] This is consistent with the data from the UK Transplant Registry, which has reported a 2.9% incidence of early HAT (occurring within 90 days of transplantation), and with the data from the center in Birmingham, which has reported a 3.1% incidence of late HAT (occurring after 90 days) during the period of study. The high incidence of HAT in AIP patients was previously unreported and is considerably higher than the rate expected for the general LT population.…”

Section: Discussionmentioning

confidence: 99%

Hepatic Artery Thrombosis

2010

High-Yield Imaging: Interventional

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Acute intermittent porphyria (AIP) is an autosomal-dominant condition resulting from a partial deficiency of the ubiquitously expressed enzyme porphobilinogen deaminase. Although its clinical expression is highly variable, a minority of patients suffer recurrent life-threatening neurovisceral attacks despite optimal medical therapy. Because the liver is the major source of excess precursor production, liver transplantation (LT) represents a potentially effective treatment for severely affected patients. Using data from the UK Transplant Registry, we analyzed all transplants performed for AIP in the United Kingdom and Ireland. Between 2002 and 2010, 10 patients underwent LT for AIP. In all cases, the indication for transplantation was recurrent, biochemically proven, medically nonresponsive acute attacks of porphyria resulting in significantly impaired quality of life. Five patients had developed significant neurological morbidities such as paraplegia before transplantation. The median follow-up time was 23.4 months, and there were 2 deaths from multiorgan failure at 98 days and 26 months. Eight recipients were alive for 3.2 to 109 months after transplantation. Complete biochemical and symptomatic resolution was observed in all patients after transplantation. However, there was a high rate of hepatic artery thrombosis (HAT; 4/10), with 1 patient requiring regrafting. The effects of previous neuronal damage such as joint contractures were not improved by transplantation. Thus, impaired quality of life in the surviving patients was usually a result of preoperative complications. Refractory AIP is an excellent indication for LT, and long-term outcomes for carefully selected patients are good. There is, however, an increased incidence of HAT in these patients, and we recommend routine antiplatelet therapy after transplantation.

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“…Although vascular complications are not as common as biliary or infectious complications, they have a much higher impact on patient and graft survival [36,37]. In order to review this complex topic, complications should be classified as being arterial or venous and as occurring early or late in the post-operative course, since these factors can determine treatment and predict outcome (Table 2).…”

Section: Postoperative Surgical Complications -Vascular and Biliarymentioning

confidence: 99%

“…In general, the incidence of vascular complications in pediatric LT varies between 2 and 30 %. Vascular complications are the major reason for graft loss in LDLT [36,37]. A study from the University of California, Los Angeles (UCLA) group found that segmental grafts had a significantly higher incidence of vascular complications (4 % in SLT, 8.7 % in LDLT, 1.7 % in whole) [37].…”

Section: Postoperative Surgical Complications -Vascular and Biliarymentioning

confidence: 99%

“…Vascular complications are the major reason for graft loss in LDLT [36,37]. A study from the University of California, Los Angeles (UCLA) group found that segmental grafts had a significantly higher incidence of vascular complications (4 % in SLT, 8.7 % in LDLT, 1.7 % in whole) [37]. In our experience, vascular complications can be minimized regardless of graft type, although we believe that grafts from very small donors (<10 kgs) may have a higher incidence of vascular complications due to their size and vessel characteristics.…”

Section: Postoperative Surgical Complications -Vascular and Biliarymentioning

confidence: 99%

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Pediatric Liver Transplantation: A Surgical Perspective and New Concepts

et al. 2014

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The first successful liver transplantation was carried out in 1967, and the recipient was a pediatric patient. Since then, many challenges have been overcome and, nowadays, 1-year patient survival after liver transplantation is about 90 % in pediatric patient populations. Standardization of surgical technique, development of better immunosuppressive medications, improved understanding of caring for patients with end-stage liver disease, and improvements in anesthesia and intensive care have had a tremendous impact on graft and patient survival. Despite all improvements, challenging issues in pediatric liver transplantation remain. In this article, we address some of these problems. and living donor liver transplantation (LDLT); improvement of intensive care treatment; development of new immunosuppressive medications; improved understanding of the balance between immunosuppression and opportunistic infection; and the adoption of a multidisciplinary team approach to patient care, which includes collaboration between transplant surgery, pediatric hepatology, pediatric intensive care, nephrology, pulmonary, cardiology, infectious disease, psychiatry, social work, pharmacy, and nutrition.Despite these good outcomes, many challenges remain in pediatric LT. Appropriate patient selection, organ shortage and the organ allocation algorithm, time of transplantation, technical problems, and opportunistic infections are some of the problems faced by transplant programs on a daily basis. This chapter addresses some of these issues.

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Vascular Complications of Orthotopic Liver Transplantation: Experience in More than 4,200 Patients

Cited by 453 publications

References 26 publications

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

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

Hepatic Artery Thrombosis

Pediatric Liver Transplantation: A Surgical Perspective and New Concepts

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