Joachim Andrassy1, Sebastian Wolf2, Verena Hoffmann3, Markus Rentsch2, Manfred Stangl2, Michael Thomas2, Sebastian Pratschke2, Lorenz Frey4, Alexander Gerbes5, Bruno Meiser6, Martin Angele2, Jens Werner2, Markus Guba2. 1. Department of General, Visceral, and Transplant Surgery, Ludwig Maximilian University, Munich, Germany. joachim.andrassy@med.uni-muenchen.de. 2. Department of General, Visceral, and Transplant Surgery, Ludwig Maximilian University, Munich, Germany. 3. Institute of Medical Information Sciences, Biometry and Epidemiology (IBE), Ludwig Maximilian University, Munich, Germany. 4. Department of Anesthesiology, Ludwig Maximilian University, Munich, Germany. 5. Department of Medicine, MED II, Ludwig Maximilian University, Munich, Germany. 6. Transplant Center, Ludwig Maximilian University, Munich, Germany.
Abstract
PURPOSE: Postoperative complications may have not only immediate but also long-term effects on the outcomes. Here, we analyzed the effect of postoperative complications requiring a reoperation (grade 3b) within the first 30 days on patients' and graft survival following liver transplantation. METHODS: Graft and patient survival in relation to donor and recipient variables and the need of reoperation for complications of 277 consecutive liver transplants performed from January 2007 to December 2012 were analyzed. RESULTS: Two hundred seventy-seven liver transplants were performed in 252 patients. Overall patient and graft survival at 1, 2, and 3 years were significantly reduced in patients requiring a reoperation. The labMELD score was significantly elevated (p = 0.04) and cold ischemia time was prolonged (p = 0.03) in recipients undergoing reoperations. Kaplan-Meier curves indicate that complications impact the outcome primarily within the first 3 months after transplantation. In multivariate analyses, the actual need of reoperation (p < 0.001), the labMELD score (p = 0.05), cold ischemia time (p = 0.02), and the need for hemodialysis pre-transplant (p = 0.05) were the only variables which correlated with the overall survival. CONCLUSION: Postoperative complications resulting in reoperations have a significant impact on the outcome primarily in the early phase after liver transplantation. Successful management of postoperative complications is key to every successful liver transplant program.
PURPOSE: Postoperative complications may have not only immediate but also long-term effects on the outcomes. Here, we analyzed the effect of postoperative complications requiring a reoperation (grade 3b) within the first 30 days on patients' and graft survival following liver transplantation. METHODS: Graft and patient survival in relation to donor and recipient variables and the need of reoperation for complications of 277 consecutive liver transplants performed from January 2007 to December 2012 were analyzed. RESULTS: Two hundred seventy-seven liver transplants were performed in 252 patients. Overall patient and graft survival at 1, 2, and 3 years were significantly reduced in patients requiring a reoperation. The labMELD score was significantly elevated (p = 0.04) and cold ischemia time was prolonged (p = 0.03) in recipients undergoing reoperations. Kaplan-Meier curves indicate that complications impact the outcome primarily within the first 3 months after transplantation. In multivariate analyses, the actual need of reoperation (p < 0.001), the labMELD score (p = 0.05), cold ischemia time (p = 0.02), and the need for hemodialysis pre-transplant (p = 0.05) were the only variables which correlated with the overall survival. CONCLUSION: Postoperative complications resulting in reoperations have a significant impact on the outcome primarily in the early phase after liver transplantation. Successful management of postoperative complications is key to every successful liver transplant program.
Authors: C E Freise; B W Gillespie; A J Koffron; A S F Lok; T L Pruett; J C Emond; J H Fair; R A Fisher; K M Olthoff; J F Trotter; R M Ghobrial; J E Everhart Journal: Am J Transplant Date: 2008-10-24 Impact factor: 8.086