Korean J Transplant.  2019 Dec;33(4):128-134. 10.4285/jkstn.2019.33.4.128.

Early reoperation after adult living-donor liver transplantation is associated with poor survival

• Lim M
• Rhu J
• Kim S
• Lee S
• Kim JM
• Choi GS
• Joh JW

• KMID: 2468163
• DOI: http://doi.org/10.4285/jkstn.2019.33.4.128

Abstract

BACKGROUND
Patients who undergo reoperation after living-donor liver transplantation (LDLT) have poor outcomes. However, the specific outcomes of patients undergoing reoperation due to gastrointestinal (GI) tract-related complications following adult LDLT are relatively unknown. In the present study, we investigated the relationship between the causes and outcomes of reoperation after LDLT and classified the risk groups.
METHODS
We performed a retrospective analysis of 506 patients who underwent LDLT at Samsung Medical Center in Seoul between 2010 and 2016.
RESULTS
Among 506 adult LDLT recipients, 98 (19.4%) underwent reoperation. The causes for reoperation included bleeding (n=39, 39.8%), vascular complications (n=26, 26.5%), wound complications (n=12, 12.2%), bile leakage (n=7, 7.1%), GI tract complications (n=6, 6.1%), and others (n=8, 8.1%). Based on a multivariate analysis, we identified prolonged operation time, hospitalization days, and a history of previous hepatocellular carcinoma-related operation as independent risk factors for reoperation. Patient survival after 3 months, 1 year, 3 years, and 5 years was 96.3%, 90.6%, 82.5%, and 79.4% in the non-reoperation group and 95.9%, 82.7%, 72.8% and 69.3% in the reoperation group, respectively. Patient survival in the reoperation group was significantly lower than that in the non-reoperation group (P=0.018). In the reoperation group, the survival rates of patients with GI tract-related complications"”including bile leakage and GI tract complications"”were significantly worse than those of patients with non-GI tract-related complications such as bleeding, vascular complications, and wound complications (P<0.001).
CONCLUSIONS
Our results showed that patient outcomes are poor after early reoperation after LDLT and that patients with GI tract-related complications have a higher risk of mortality.

Keyword

Living donors; Liver transplantation; Postoperative complications; Reoperation

MeSH Terms

Adult*
Bile
Gastrointestinal Tract
Hemorrhage
Hospitalization
Humans
Liver Transplantation*
Liver*
Living Donors
Mortality
Multivariate Analysis
Postoperative Complications
Reoperation*
Retrospective Studies
Risk Factors
Seoul
Survival Rate
Wounds and Injuries

Figure

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  Fig. 1 Overall survival rate of patients in the reoperation and non-reoperation groups within 30 days after living-donor liver transplantation.

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  Fig. 2 Overall survival rate of patients in the gastrointestinal (GI) tract-related complications group and non-GI tract-related complications group.

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