Highlights
- •Liver transplant recipient BMI greater than 30 and donor history of heavy alcohol use is associated with an 80% return rate to the operating room.
- •During liver transplantation, clot strength less than 45 mm during the anheptic and early reperfusion is associated with greater than 20 units of intraoperative blood loss and 80% return rate to the operating room.
- •The combination of coagulopathy, obesity, and donor alcohol heavy use is associated with an 100% rate of return to the operating room.
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.
Keywords
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References
- Reoperative complications after primary orthotopic liver transplantation: a contemporary single-center experience in the post-model for end-stage liver disease era.J Am Coll Surg. 2014; 219: 993-1000
- Damage control as a strategy to manage postreperfusion hemodynamic instability and coagulopathy in liver transplant.JAMA surgery. 2015; 150: 1066-1072
- Damage control': an approach for improved survival in exsanguinating penetrating abdominal injury.J Trauma. 1993; 35 (discussion 382-373): 375-382
- Major abdominal vascular trauma--a unified approach.J Trauma. 1982; 22: 672-679
- Extreme hyponatremia as a risk factor for early mortality after liver transplantation in the MELD-sodium era.Transpl Int. 2021; 34: 2856-2868
- Use of tissue plasminogen activator in liver transplantation from donation after cardiac death donors.Am J Transplant : Off J Am Soc Transplant Am Soc Transplant Surgeons. 2010; 10: 2665-2672
- A clinical coagulopathy score concurrent with viscoelastic testing defines opportunities to improve hemostatic resuscitation and enhance blood product utilization during liver transplantation.Am J Surg. 2020; 220(6): 1379-1386
- Heavy alcohol use among deceased donors does not impact recipient outcomes after liver transplantation.Transplantation. 2018; 102: 1864-1869
- Predictive model and risk factors associated with a revised definition of early allograft dysfunction in liver transplant recipients.Clin Transplant. 2017; 31
- Staged biliary reconstruction after orthotopic liver transplantation: a practical surgical strategy for high-acuity adult recipients.Transplant Direct. 2019; 5: e482
- Morbid obesity in liver transplant recipients adversely affects longterm graft and patient survival in a single-institution analysis.HPB. 2015; 17: 251-257
- NASH leading cause of liver transplant in women: updated analysis of indications for liver transplant and Ethnic and Gender variances.Am J Gastroenterol. 2018; 113: 1649-1659
- Modeling the epidemic of nonalcoholic fatty liver disease demonstrates an exponential increase in burden of disease.Hepatology. 2018; 67: 123-133
- Nonalcoholic steatohepatitis: a Review.JAMA : J Am Med Assoc. 2020; 323: 1175-1183
- Influence of high donor serum sodium levels on early postoperative graft function in human liver transplantation: effect of correction of donor hypernatremia.Liver Transplant Surg. 1999; 5: 421-428
- Prognostic factors influencing outcome in adult liver transplantation using hypernatremic organ donation after brain death.Hepatobiliary Pancreat Dis Int. 2020; 19: 371-377
- Alcohol abuse in deceased liver donors: impact on post-transplant outcomes.Liver Int. 2015; 35: 171-175
- The UK DCD Risk Score: a new proposal to define futility in donation-after-circulatory-death liver transplantation.J Hepatol. 2018; 68: 456-464
- Intraoperative blood loss predicts hemorrhage-related reoperation after orthotopic liver transplantation.Am Surg. 2010; 76: 969-973
- Intraoperative changes in blood coagulation and thrombelastographic monitoring in liver transplantation.Anesth Analg. 1985; 64: 888-896
- Systemic effects of tissue plasminogen activator-associated fibrinolysis and its relation to thrombin generation in orthotopic liver transplantation.Transplantation. 1989; 47: 978-984
- Use of higher thromboelastogram transfusion values is not associated with greater blood loss in liver transplant surgery.Liver Transplant : Off Public Am Assoc Study Liver Diseases Int Liver Transplant Soc. 2012; 18: 1254-1258
- The impact of intraoperative transfusion of platelets and red blood cells on survival after liver transplantation.Anesth Analg. 2008; 106 (table of contents): 32-44
- Platelet transfusion during liver transplantation is associated with increased postoperative mortality due to acute lung injury.Anesth Analg. 2009; 108: 1083-1091
- Platelets and survival after liver transplantation.Anesth Analg. 2009; 108 (author reply 1355): 1354-1355
- Non-alcoholic fatty liver disease and liver transplantation: outcomes and advances.World J Gastroenterol. 2013; 19: 9146-9155
- Sleeve gastrectomy prior to liver transplantation is superior to medical weight loss in reducing posttransplant metabolic complications.Am J Transplant : Off J Am Soc Transplantat Am Soc Transplant Surgeons. 2021; 21(10): 3324-3332
- Outcomes after declining a steatotic donor liver for liver transplant candidates in the United States.Transplantation. 2020; 104: 1612-1618
- Thromboelastography-guided transfusion decreases intraoperative blood transfusion during orthotopic liver transplantation: randomized clinical trial.Transplant Proc. 2010; 42: 2590-2593
- Use of rotational thromboelastometry in liver transplantation is associated with reduced transfusion requirements.Exp Clin Transplant. 2019; 17: 222-230
- Detection of early allograft dysfunction at 30 min of reperfusion in liver transplantation: an intraoperative diagnostic tool with real time assessment of graft function.Am J Surg. 2020; 220(6): 1518-1525
Article info
Publication history
Published online: February 18, 2022
Accepted:
February 16,
2022
Received in revised form:
February 8,
2022
Received:
June 29,
2021
Identification
Copyright
© 2022 Elsevier Inc. All rights reserved.
