Complications requiring operative intervention after orthotopic liver transplantation.

Survival rates after liver transplantation continue to improve, but the postoperative morbidity in these patients remains significant. The clinical courses of 96 consecutive patients who received transplants were reviewed retrospectively. Forty-two patients experienced complications requiring surgical intervention. These complications were primarily related to biliary tract reconstruction, bowel complications, and septic complications. None of the factors examined, except a second transplant procedure, proved helpful in identifying those patients most likely to experience surgical complications; however, a risk factor scoring system was found to accurately identify that group of patients at highest risk of dying in the postoperative period. Only 2 of 21 deaths could be attributed directly to the surgical complication. We believe that a policy of prompt, aggressive surgical intervention, coupled with careful tailoring of immunosuppression to both the patient and the clinical situation, can lead to a low mortality rate in patients who require reoperation.