A meta-analysis of complications following deceased donor liver transplant

Abstract

Background Liver transplantation is a complex surgery associated with high rates of postoperative complications. While national outcomes data are available, national rates of most complications are unknown. Data Sources A systematic review of the literature reporting rates of postoperative complications between 2002 and 2012 was performed. A cohort of 29,227 deceased donor liver transplant recipients from 74 studies was used to calculate pooled incidences were for 17 major postoperative complications. Conclusions This is the first comprehensive review of postoperative complications after liver transplantation and can serve as a guide for transplant and non-transplant clinicians. Efforts to collect national data on complications, such as through the National Surgical Quality Improvement Program, would improve the ability to provide patients with informed consent, serve as a tool for individual center performance monitoring, and provide a central source against which to measure interventions aimed at improving patient care.

Delayed primary closure and the incidence of surgical complications in pediatric liver transplant recipients

“…Moreover, education of families is vital in ensuring the success of longer-term surveillance of patients in detecting complications of more delayed-onset. Our rates of wound infection (2.5%), wound dehiscence (2.1%) and incisional hernias (0.7%) were low and compared favorably with literature [3,9]. This low instance of wound infection may have been underreported, as this is usually a comparatively minor complication and hence less accurately recorded.…”

“…Conversely, the use of split and other marginal liver grafts, either from a cadaveric or living related donor, allows for timely transplantation, reducing wait list morbidity and mortality [10]. Postoperative morbidity in children arises owing to a number of contributing factors including pretransplant morbidity, such as malnutrition, graft type and quality, previous abdominal procedures, surgical and anesthetic expertise and postoperative management [9]. Bowel perforation has a reported incidence between 2.5% and 20% and a related high mortality rate of 30%-50% [11][12][13][14][15], making early diagnosis and appropriate postoperative management essential.…”

“…Pediatric LT remains a skill intensive, lifesaving operative procedure with high rates of postoperative surgical complications [8,9]. Despite this, LT remains the gold standard for the treatment of end stage liver disease.…”

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“…McElroy and associates 11 recently published an excellent meta-analysis. This analysis of 29 227 recipients of deceased-donor liver transplants from 74 studies identified 17 types of postoperative complications.…”

“…They also stated that the postoperative pneumonia rate could be reduced by systematic and intensive pulmonary rehabilitation, described in general surgery patients. 11 Almost one-quarter of the analyzed studies were associated with pulmonary complications, with these studies stating that the complications could be prevented by rehabilitation. As in the meta-analysis, our series also identified pneumonia as the main cause of ARF.…”