Analysis of early relaparotomy following living donor liver transplantation

Abstract

We retrospectively analyzed the causes, risk factors, and impact of early relaparotomy after adult-to-adult living donor liver transplantation (LDLT) on the posttransplant outcome. Adult recipients who underwent initial LDLT at our institution between August 1997 and August 2015 (n = 196) were included. Any patients who required early retransplantation were excluded. Early relaparotomy was defined as surgical treatment within 30 days after LDLT. Relaparotomy was performed 66 times in 52 recipients (a maximum of 4 times in 1 patient). The reasons for relaparotomy comprised postoperative bleeding (39.4%), vascular complications (27.3%), suspicion of abdominal sepsis or bile leakage (25.8%), and others (7.6%). A multivariate analysis revealed that previous upper abdominal surgery and prolonged operative time were independent risk factors for early relaparotomy. The overall survival rate in the relaparotomy group was worse than that in the nonrelaparotomy group (6 months, 67.3% versus 90.1%, P < 0.001; 1 year, 67.3% versus 88.6%, P < 0.001; and 5 years, 62.6% versus 70.6%, P = 0.06). The outcome of patients who underwent 2 or more relaparotomies was worse compared with patients who underwent only 1 relaparotomy. In a subgroup analysis according to the cause of initial relaparotomy, the survival rate of the postoperative bleeding group was comparable with the nonrelaparotomy group (P = 0.96). On the other hand, the survival rate of the vascular complication group was significantly worse than that of the nonrelaparotomy group (P = 0.001). Previous upper abdominal surgery is a risk factor for early relaparotomy after LDLT. A favorable longterm outcome is expected in patients who undergo early relaparotomy due to postoperative bleeding. Liver Transplantation 22 1519-1525 2016 AASLD.

The Causes and Outcomes of Early Relaparotomy Following Pediatric Living Donor Liver Transplantation

“…Further analyses with a larger number of patients in a well‐designed multicenter study are needed to clarify the impact of early relaparotomy on outcomes. In addition, we defined early relaparotomy as a surgical intervention performed within 3 months after LDLT or during the initial hospital stay after LDLT described in recent studies . In some patients, the initial hospital stay of pediatric LDLT recipients lasted several months, and bacterial infections have been reported to be predominant during the first 2 months after transplantation .…”

“…Early relaparotomy of a recipient after adult living donor liver transplantation (LDLT) is significantly associated with a poor prognosis . Some studies have reported that the survival rate among those who require early relaparotomy is approximately 60%‐70%, which is lower than that of those who do not require early relaparotomy .…”

Chronological changes in skeletal muscle mass following living‐donor liver transplantation: An analysis of the predictive factors for long‐term post‐transplant low muscularity

“…From January 2008 to June 2016, a total of 150 adult patients underwent LDLT at Nagasaki University Hospital. Technical details about the surgical procedure applied for LDLT have already been described elsewhere . Twelve patients were excluded due to their imaging data being unavailable.…”

“…A tube jejunostomy was placed at the time of LT, and 24 hours postoperatively, enteral nutrition with Elental (Ajinomoto Pharmaceutical Ltd, Tokyo, Japan) was instituted as also previously described . The calories load was 1 kcal/mL, and the initial infusion rate was 10 mL/h.…”

Pretransplant serum procalcitonin level for prediction of early post‐transplant sepsis in living donor liver transplantation

“…If the patient had pretransplant infection within 2 weeks prior to LDLT, their antimicrobial therapy was continued perioperatively. Prophylactic valganciclovir (10 mg/kg/day) was given for 14 days when anticytomegalovirus immunoglobulin G was positive in the donor and negative in the recipient; trimethoprim–sulfamethoxazole (1 g daily) was given for Pneumocystis jirovecii pneumonia prophylaxis for 3 months . Early nutritional therapy was given to all recipients by tube jejunostomy or nasojejunal feeding tube from the day of LDLT to the day when the recipient could eat sufficiently.…”