Factors Associated with Prolonged Recipient Hepatectomy Time During Liver Transplantation: A Single‐Centre Experience

Abstract

Background Recipient hepatectomy during liver transplantation can be a challenging operation and can increase cold ischaemic time. The aim of this study is to assess factors associated with prolonged recipient hepatectomy. Methods From 2005 to 2015, 930 patients were submitted to liver transplantation in our hospital. Prolonged hepatectomy time was defined as operative time [180 min (from knife on skin to total hepatectomy). Patients undergoing early liver retransplantation and living donation were excluded. Results A total of 715 patients were included in our study. Median age at transplantation was 53 (18-70) years, and median BMI was 26.2 (16-40). Median hepatectomy time was 131 min. Prolonged hepatectomy time occurred in 89 (12.4%) patients. At univariate analysis, previous decompensated cirrhosis with variceal bleeding and/or ascites, higher BMI and previous abdominal surgery were associated with prolonged operating time. Higher surgeon experience and acute liver failure were associated with shorter hepatectomy time. At multivariate analysis, previous episodes of variceal bleeding (p = 0.027, OR 1.78), BMI [ 27 (p = 0.01, OR 1.75), previous abdominal surgery (p = 0.04, OR 1.68) and surgeon experience (p = 0.007, OR 2.04) were independently associated with operating time. Prolonged hepatectomy time was significantly associated with cold and total ischaemic time and intraoperative bleeding (p \ 0.001, p = 0.002 and p = 0.002, respectively). Conclusions Recipient BMI, previous episodes of variceal bleeding, previous abdominal surgery and surgeon experience are independently associated with hepatectomy duration. These factors can be helpful to identify those patients with potentially prolonged hepatectomy time, and therefore, strategies can be put in place to optimize outcomes in this group of patients.

Liver Transplantation for Biliary Atresia in Adulthood: Single-Centre Surgical Experience

“…The median hepatectomy time in our series was 160 min, with the longest at 280 min, which is above the 60–120 min considered as the standard. Ausania et al defined a cut-off of 180 min for prolonged hepatectomy, which was based on with previous abdominal surgeries, surgical experience, and PHT [ 28 ]. In total, 44% of our patients fulfilled these criteria.…”

The Impact of Time Interval between Hepatic Resection and Liver Transplantation on Clinical Outcome in Patients with Hepatocellular Carcinoma

“…This could be explained by the fact that tertiary referral centers with consistent experience in HPB surgery and LT may have benefits in both fields, especially when these fields are related to each other [ 20 , 21 ]. Only ICU stay and operation duration were outside the BM, the latter likely due to a longer time spent on adhesiolysis, normally occurring in patients with prior upper abdominal surgery [ 22 , 23 , 24 ].…”

Cold ischemia time in liver transplantation: An overview

“…However recipient hepatectomy can be challenging due to local conditions such as portal hypertension and perihilar inflammation so it can delay the liver graft reperfusion in the recipient. Median recipient hepatectomy times reported vary widely from 45 min[ 56 , 57 ] to 131 min[ 58 ] but previous decompensated cirrhosis with variceal bleeding and/or ascites, higher body mass index, previous abdominal surgery, and surgeon experience are independently associated with prolonged recipient hepatectomy (> 131 min) which is associated significantly with CIT. Back table preparation can be performed in the recipient hospital or in the donor hospital immediately after the removal of the graft to avoid any additional CIT.…”