Hunter B Moore1, Yanik J Bababekov2, James J Pomposelli2, Megan A Adams3, Cara Crouch4, Dor Yoeli2, Rashikh A Choudhury2, Tanner Ferrell2, James R Burton5, Elizabeth A Pomfret2, Trevor L Nydam2. 1. Department of Surgery, Division of Transplant Surgery, University of Colorado, USA. Electronic address: hunter.moore@cuanschutz.edu. 2. Department of Surgery, Division of Transplant Surgery, University of Colorado, USA. 3. Department of Surgery, Division of Transplant Surgery, University of Colorado, USA; Department of Surgery, Division of Transplant Surgery, Children's Hospital Colorado, USA. 4. Department of Anesthesia, University of Colorado, USA. 5. Department of Medicine, Division of Transplant Hepatology, University of Colorado, USA.
Abstract
INTRODUCTION: One in four liver transplants (LT) require return to the operating room(R-OR) within 48 h of surgery. We hypothesize that donor, recipient, and intraoperative factors will predict R-OR. METHODS: LT recipients were enrolled in an observational study to measure coagulation with thrombelastography (TEG) were assessed with transplant recipient and donor variables for risk of R-OR. RESULTS: 160 recipients with a median age of 55 years and a MELD-Na of 22 were analyzed. R-OR occurred in 22%. Recipient BMI (p = 0.006), donor heavy alcohol use (p = 0.017), TEG MA (p = 0.013) during the anhepatic phase of surgery, TEG MA at anhepatic and 30-min after reperfusion (p < 0.05), and red blood cell transfusions (p < 0.001) were associated with R-OR. CONCLUSION: The vexing triad of recipient obesity, heavy donor alcohol use, and low TEG MA were associated with a high rate of R-OR. Strategies to reduce this sub-optimal combination of risk factors could reduce the frequency of unplanned re-operations.
INTRODUCTION: One in four liver transplants (LT) require return to the operating room(R-OR) within 48 h of surgery. We hypothesize that donor, recipient, and intraoperative factors will predict R-OR. METHODS: LT recipients were enrolled in an observational study to measure coagulation with thrombelastography (TEG) were assessed with transplant recipient and donor variables for risk of R-OR. RESULTS: 160 recipients with a median age of 55 years and a MELD-Na of 22 were analyzed. R-OR occurred in 22%. Recipient BMI (p = 0.006), donor heavy alcohol use (p = 0.017), TEG MA (p = 0.013) during the anhepatic phase of surgery, TEG MA at anhepatic and 30-min after reperfusion (p < 0.05), and red blood cell transfusions (p < 0.001) were associated with R-OR. CONCLUSION: The vexing triad of recipient obesity, heavy donor alcohol use, and low TEG MA were associated with a high rate of R-OR. Strategies to reduce this sub-optimal combination of risk factors could reduce the frequency of unplanned re-operations.
Authors: Kyle R Jackson; Mary G Bowring; Courtenay Holscher; Christine E Haugen; Jane J Long; Luckmini Liyanage; Allan B Massie; Shane Ottmann; Benjamin Philosophe; Andrew M Cameron; Dorry L Segev; Jacqueline Garonzik-Wang Journal: Transplantation Date: 2020-08 Impact factor: 4.939
Authors: Ramona Nicolau-Raducu; Ari J Cohen; Amjad Bokhari; Humberto Bohorquez; David Bruce; Ian Carmody; Emily Bugeaud; John Seal; Dennis Sonnier; Bobby Nossaman; George Loss Journal: Clin Transplant Date: 2017-09-21 Impact factor: 2.863
Authors: Andrea Schlegel; Marit Kalisvaart; Irene Scalera; Richard W Laing; Hynek Mergental; Darius F Mirza; Thamara Perera; John Isaac; Philipp Dutkowski; Paolo Muiesan Journal: J Hepatol Date: 2017-11-15 Impact factor: 25.083