John T Baber1, Jonathan R Hiatt1, Ronald W Busuttil2, Vatche G Agopian3. 1. Department of Surgery, Division of General Surgery, David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles, CA. 2. Department of Surgery, Dumont-UCLA Transplant and Liver Cancer Centers, Pfleger Liver Institute, David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles, CA. 3. Department of Surgery, Dumont-UCLA Transplant and Liver Cancer Centers, Pfleger Liver Institute, David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles, CA. Electronic address: vagopian@mednet.ucla.edu.
Abstract
BACKGROUND: Although it is the only curative treatment for polycystic liver disease (PLD), orthotopic liver transplantation (OLT) has been reserved for severely symptomatic, malnourished, or refractory patients who are not candidates for palliative disease-directed interventions (DDI). Data on the effect of previous DDIs on post-transplant morbidity and mortality are scarce. We analyzed the outcomes after OLT for PLD recipients, and determined the effects of previous palliative surgical intervention on post-transplantation morbidity and mortality. STUDY DESIGN: We performed a retrospective analysis of factors affecting perioperative outcomes after OLT for PLD between 1992 and 2013, including comparisons of recipients with previous major open DDIs (Open DDI, n = 12) with recipients with minimally invasive or no previous DDIs (minimal DDI, n = 16). RESULTS: Over the 20-year period, 28 recipients underwent OLT for PLD, with overall 30-day, 1-, and 5-year graft and patient survivals of 96%, 89%, 75%, and 96%, 93%, 79%, respectively. Compared with the minimal DDI group, open DDI recipients accounted for all 5 deaths, had inferior 90-day and 1- and 5-year survivals (83%, 83%, and 48% vs 100%, 100%, 100%; p = 0.009), and greater intraoperative (42% vs 0%; p = 0.003), total (58% vs 19%; p = 0.031), and Clavien grade IV or greater (50% vs 6%; p = 0.007) postoperative complications, more unplanned reoperations (50% vs 13%; p = 0.003), and longer total hospital (27 days vs 17 days; p = 0.035) and ICU (10 days vs 4 days; p = 0.045) stays. CONCLUSIONS: In one of the largest single-institution experiences of OLT for PLD, we report excellent long-term graft and patient survival. Previous open DDIs are associated with increased risks of perioperative morbidity and mortality. Improved identification of PLD patients bound for OLT may mitigate perioperative complications and potentially improve post-transplantation outcomes.
BACKGROUND: Although it is the only curative treatment for polycystic liver disease (PLD), orthotopic liver transplantation (OLT) has been reserved for severely symptomatic, malnourished, or refractory patients who are not candidates for palliative disease-directed interventions (DDI). Data on the effect of previous DDIs on post-transplant morbidity and mortality are scarce. We analyzed the outcomes after OLT for PLD recipients, and determined the effects of previous palliative surgical intervention on post-transplantation morbidity and mortality. STUDY DESIGN: We performed a retrospective analysis of factors affecting perioperative outcomes after OLT for PLD between 1992 and 2013, including comparisons of recipients with previous major open DDIs (Open DDI, n = 12) with recipients with minimally invasive or no previous DDIs (minimal DDI, n = 16). RESULTS: Over the 20-year period, 28 recipients underwent OLT for PLD, with overall 30-day, 1-, and 5-year graft and patient survivals of 96%, 89%, 75%, and 96%, 93%, 79%, respectively. Compared with the minimal DDI group, open DDI recipients accounted for all 5 deaths, had inferior 90-day and 1- and 5-year survivals (83%, 83%, and 48% vs 100%, 100%, 100%; p = 0.009), and greater intraoperative (42% vs 0%; p = 0.003), total (58% vs 19%; p = 0.031), and Clavien grade IV or greater (50% vs 6%; p = 0.007) postoperative complications, more unplanned reoperations (50% vs 13%; p = 0.003), and longer total hospital (27 days vs 17 days; p = 0.035) and ICU (10 days vs 4 days; p = 0.045) stays. CONCLUSIONS: In one of the largest single-institution experiences of OLT for PLD, we report excellent long-term graft and patient survival. Previous open DDIs are associated with increased risks of perioperative morbidity and mortality. Improved identification of PLD patients bound for OLT may mitigate perioperative complications and potentially improve post-transplantation outcomes.
Authors: Fouad T Chebib; Amber Harmon; Maria V Irazabal Mira; Yeon Soon Jung; Marie E Edwards; Marie C Hogan; Patrick S Kamath; Vicente E Torres; David M Nagorney Journal: J Am Coll Surg Date: 2016-01-14 Impact factor: 6.113