The causes, risk factors, and outcomes of early relaparotomy after living-donor liver transplantation

Shohei Yoshiya, Ken Shirabe, Koichi Kimura, Tomoharu Yoshizumi, Toru Ikegami, Hiroto Kayashima, Takeo Toshima, Hideaki Uchiyama, Yuji Soejima, Yoshihiko Maehara

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19 Citations (Scopus)

Abstract

BACKGROUND: Although early relaparotomy of the recipient after living-donor liver transplantation (LDLT) is a significant event, its causes, risk factors, and outcomes are still unclear. METHODS: A retrospective analysis of 284 cases of adult-to-adult LDLT was performed. RESULTS: The incidence of early relaparotomy of the recipient was 9.2% (n=26). The reasons for relaparotomy were divided into three groups: postoperative bleeding (n=11, 42.3%), insufficient portal venous flow (n=5, 19.2%), and other (n=10, 38.5%). The 6-month graft survival rates of patients in the early laparotomy and nonlaparotomy groups were 61.5% and 88.4%, respectively (P<0.0001). Patients with postoperative bleeding experienced a significantly higher mortality rate (54.6%) than those with other reasons for early relaparotomy (13.3%; P=0.0231). Multivariate analysis showed that a model for end-stage liver disease score of greater than 20 (odds ratio [OR], 9.06; P=0.0434) and an operative blood loss of greater than 15 L (OR, 9.06; P=0.0434) were significant risk factors for graft loss after early relaparotomy. In patients with patent major shunt vessels (>1 cm in diameter, n=31), portal venous flow of less than 1.0 L/min at the end of surgery was a significant risk factor for early relaparotomy to ligate the remaining shunt vessels (OR, 50.5; P=0.0188). CONCLUSIONS: Early relaparotomy of the recipient is significantly associated with poor graft survival after LDLT. Massive intraoperative blood loss and high model for end-stage liver disease score were associated with poor graft survival in the relaparotomy group.

Original languageEnglish
Pages (from-to)947-952
Number of pages6
JournalTransplantation
Volume94
Issue number9
DOIs
Publication statusPublished - Nov 15 2012

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Living Donors
Graft Survival
Liver Transplantation
End Stage Liver Disease
Laparotomy
Survival Rate
Hemorrhage
Incidence

All Science Journal Classification (ASJC) codes

  • Transplantation

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The causes, risk factors, and outcomes of early relaparotomy after living-donor liver transplantation. / Yoshiya, Shohei; Shirabe, Ken; Kimura, Koichi; Yoshizumi, Tomoharu; Ikegami, Toru; Kayashima, Hiroto; Toshima, Takeo; Uchiyama, Hideaki; Soejima, Yuji; Maehara, Yoshihiko.

In: Transplantation, Vol. 94, No. 9, 15.11.2012, p. 947-952.

Research output: Contribution to journalArticle

Yoshiya, S, Shirabe, K, Kimura, K, Yoshizumi, T, Ikegami, T, Kayashima, H, Toshima, T, Uchiyama, H, Soejima, Y & Maehara, Y 2012, 'The causes, risk factors, and outcomes of early relaparotomy after living-donor liver transplantation', Transplantation, vol. 94, no. 9, pp. 947-952. https://doi.org/10.1097/TP.0b013e31826969e6
Yoshiya, Shohei ; Shirabe, Ken ; Kimura, Koichi ; Yoshizumi, Tomoharu ; Ikegami, Toru ; Kayashima, Hiroto ; Toshima, Takeo ; Uchiyama, Hideaki ; Soejima, Yuji ; Maehara, Yoshihiko. / The causes, risk factors, and outcomes of early relaparotomy after living-donor liver transplantation. In: Transplantation. 2012 ; Vol. 94, No. 9. pp. 947-952.
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T1 - The causes, risk factors, and outcomes of early relaparotomy after living-donor liver transplantation

AU - Yoshiya, Shohei

AU - Shirabe, Ken

AU - Kimura, Koichi

AU - Yoshizumi, Tomoharu

AU - Ikegami, Toru

AU - Kayashima, Hiroto

AU - Toshima, Takeo

AU - Uchiyama, Hideaki

AU - Soejima, Yuji

AU - Maehara, Yoshihiko

PY - 2012/11/15

Y1 - 2012/11/15

N2 - BACKGROUND: Although early relaparotomy of the recipient after living-donor liver transplantation (LDLT) is a significant event, its causes, risk factors, and outcomes are still unclear. METHODS: A retrospective analysis of 284 cases of adult-to-adult LDLT was performed. RESULTS: The incidence of early relaparotomy of the recipient was 9.2% (n=26). The reasons for relaparotomy were divided into three groups: postoperative bleeding (n=11, 42.3%), insufficient portal venous flow (n=5, 19.2%), and other (n=10, 38.5%). The 6-month graft survival rates of patients in the early laparotomy and nonlaparotomy groups were 61.5% and 88.4%, respectively (P<0.0001). Patients with postoperative bleeding experienced a significantly higher mortality rate (54.6%) than those with other reasons for early relaparotomy (13.3%; P=0.0231). Multivariate analysis showed that a model for end-stage liver disease score of greater than 20 (odds ratio [OR], 9.06; P=0.0434) and an operative blood loss of greater than 15 L (OR, 9.06; P=0.0434) were significant risk factors for graft loss after early relaparotomy. In patients with patent major shunt vessels (>1 cm in diameter, n=31), portal venous flow of less than 1.0 L/min at the end of surgery was a significant risk factor for early relaparotomy to ligate the remaining shunt vessels (OR, 50.5; P=0.0188). CONCLUSIONS: Early relaparotomy of the recipient is significantly associated with poor graft survival after LDLT. Massive intraoperative blood loss and high model for end-stage liver disease score were associated with poor graft survival in the relaparotomy group.

AB - BACKGROUND: Although early relaparotomy of the recipient after living-donor liver transplantation (LDLT) is a significant event, its causes, risk factors, and outcomes are still unclear. METHODS: A retrospective analysis of 284 cases of adult-to-adult LDLT was performed. RESULTS: The incidence of early relaparotomy of the recipient was 9.2% (n=26). The reasons for relaparotomy were divided into three groups: postoperative bleeding (n=11, 42.3%), insufficient portal venous flow (n=5, 19.2%), and other (n=10, 38.5%). The 6-month graft survival rates of patients in the early laparotomy and nonlaparotomy groups were 61.5% and 88.4%, respectively (P<0.0001). Patients with postoperative bleeding experienced a significantly higher mortality rate (54.6%) than those with other reasons for early relaparotomy (13.3%; P=0.0231). Multivariate analysis showed that a model for end-stage liver disease score of greater than 20 (odds ratio [OR], 9.06; P=0.0434) and an operative blood loss of greater than 15 L (OR, 9.06; P=0.0434) were significant risk factors for graft loss after early relaparotomy. In patients with patent major shunt vessels (>1 cm in diameter, n=31), portal venous flow of less than 1.0 L/min at the end of surgery was a significant risk factor for early relaparotomy to ligate the remaining shunt vessels (OR, 50.5; P=0.0188). CONCLUSIONS: Early relaparotomy of the recipient is significantly associated with poor graft survival after LDLT. Massive intraoperative blood loss and high model for end-stage liver disease score were associated with poor graft survival in the relaparotomy group.

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