Abu Bakar Hafeez Bhatti1, Faisal Saud Dar2, Ammal Imran Qureshi2, Nusrat Yar Khan2, Haseeb Haider Zia2, Eitzaz Ud Din Khan3, Nasir Ayub Khan3, Mohammad Salih4, Najmul Hassan Shah4. 1. Department of HPB Surgery and Liver Transplantation, Shifa International Hospital Islamabad, Sector H-8/4, Islamabad, Pakistan. Electronic address: Abubakar.hafeez@yahoo.com. 2. Department of HPB Surgery and Liver Transplantation, Shifa International Hospital Islamabad, Sector H-8/4, Islamabad, Pakistan. 3. Department of Anesthesiology, Shifa International Hospital Islamabad, Sector H-8/4, Islamabad, Pakistan. 4. Department of Gastroenterology and Hepatology, Shifa International Hospital Islamabad, Sector H-8/4, Islamabad, Pakistan.
Abstract
BACKGROUND: As a quality assessment tool, failure to rescue (FTR) has been employed in various surgical specialties. However, its role in liver transplantation has only recently been explored. To the best of our knowledge, role of FTR in living donor liver transplant (LDLT) has not been assessed previously. The objective of the current study was to determine failure to rescue (FTR) rate and it's predictors in an LDLT center. MATERIALS AND METHODS: We reviewed a prospectively maintained database of patients who underwent LDLT at our center between 2012 and 2016. Patients who experienced grade 3B or above complications on Clavien-Dindo grading were included in this study. Primary outcome of interest was FTR rate in these patients. FTR was defined as a preventable major complication followed by death within one year after transplantation. We also looked at independent predictors of FTR in our patients and a multivariate analysis was performed. RESULTS: Median age was 48.4(18-73) years. Male to female ratio was 3.3:1. Median MELD score was 17(6-42). The FTR rate in the current study was 52/131 (39.6%). Infectious complications were more common in the FTR group i.e. 22/32(68.8%) versus 10/32 (31.2%) (P < 0.0001). Biliary complications were more common in the non-FTR group i.e. 49/62 (79.1%) versus 13/62 (20.9%) (P < 0.0001). On multivariate analysis, there was a 60% increase in mortality following a major complication in the presence of early allograft dysfunction (Hazard ratio: 1.6, Confidence interval; 1.2-2.2, P = 0.002). A 40% reduction in FTR was seen in patients with a biliary complication versus other complications (Hazard ratio: 0.6, Confidence interval = 0.4-0.8, P = 0.009). CONCLUSION: Early allograft dysfunction and biliary complications are independent predictors of FTR in LDLT.
BACKGROUND: As a quality assessment tool, failure to rescue (FTR) has been employed in various surgical specialties. However, its role in liver transplantation has only recently been explored. To the best of our knowledge, role of FTR in living donor liver transplant (LDLT) has not been assessed previously. The objective of the current study was to determine failure to rescue (FTR) rate and it's predictors in an LDLT center. MATERIALS AND METHODS: We reviewed a prospectively maintained database of patients who underwent LDLT at our center between 2012 and 2016. Patients who experienced grade 3B or above complications on Clavien-Dindo grading were included in this study. Primary outcome of interest was FTR rate in these patients. FTR was defined as a preventable major complication followed by death within one year after transplantation. We also looked at independent predictors of FTR in our patients and a multivariate analysis was performed. RESULTS: Median age was 48.4(18-73) years. Male to female ratio was 3.3:1. Median MELD score was 17(6-42). The FTR rate in the current study was 52/131 (39.6%). Infectious complications were more common in the FTR group i.e. 22/32(68.8%) versus 10/32 (31.2%) (P < 0.0001). Biliary complications were more common in the non-FTR group i.e. 49/62 (79.1%) versus 13/62 (20.9%) (P < 0.0001). On multivariate analysis, there was a 60% increase in mortality following a major complication in the presence of early allograft dysfunction (Hazard ratio: 1.6, Confidence interval; 1.2-2.2, P = 0.002). A 40% reduction in FTR was seen in patients with a biliary complication versus other complications (Hazard ratio: 0.6, Confidence interval = 0.4-0.8, P = 0.009). CONCLUSION: Early allograft dysfunction and biliary complications are independent predictors of FTR in LDLT.
Authors: Justin S Hatchimonji; Elinore J Kaufman; Catherine E Sharoky; Lucy Ma; Anna E Garcia Whitlock; Daniel N Holena Journal: J Trauma Acute Care Surg Date: 2019-09 Impact factor: 3.313
Authors: Tao Lv; LingXiang Kong; Jiayin Yang; Hong Wu; Tianfu Wen; Li Jiang; Jian Yang Journal: Medicine (Baltimore) Date: 2020-01 Impact factor: 1.817