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Early reoperation after adult living-donor liver transplantation is associated with poor survival

대한이식학회지 2019년 33권 4호 p.128 ~ 134
 ( Lim Manuel ) - Sungkyunkwan University School of Medicine Samsung Medical Center Department of Surgery

 ( Rhu Jin-Soo ) - Sungkyunkwan University School of Medicine Samsung Medical Center Department of Surgery
김상진 ( Kim Sang-Jin ) - Sungkyunkwan University School of Medicine Samsung Medical Center Department of Surgery
 ( Lee Seo-Hee ) - Sungkyunkwan University School of Medicine Samsung Medical Center Department of Surgery
김종만 ( Kim Jong-Man ) - Sungkyunkwan University School of Medicine Samsung Medical Center Department of Surgery
최규성 ( Choi Gyu-Seong ) - Sungkyunkwan University School of Medicine Samsung Medical Center Department of Surgery
조재원 ( Joh Jae-Won ) - Sungkyunkwan University School of Medicine Samsung Medical Center Department of Surgery

Abstract


Background: Patients who undergo reoperation after living-donor liver transplantation (LDLT) have poor outcomes. However, the specific outcomes of patients undergoing reoperation due to gastrointestinal (GI) tract-related complications following adult LDLT are relatively unknown. In the present study, we investigated the relationship between the causes and outcomes of reoperation after LDLT and classified the risk groups.

Methods: We performed a retrospective analysis of 506 patients who underwent LDLT at Samsung Medical Center in Seoul between 2010 and 2016.

Results: Among 506 adult LDLT recipients, 98 (19.4%) underwent reoperation. The causes for reoperation included bleeding (n=39, 39.8%), vascular complications (n=26, 26.5%), wound complications (n=12, 12.2%), bile leakage (n=7, 7.1%), GI tract complications (n=6, 6.1%), and others (n=8, 8.1%). Based on a multivariate analysis, we identified prolonged operation time, hospitalization days, and a history of previous hepatocellular carcinoma-related operation as independent risk factors for reoperation. Patient survival after 3 months, 1 year, 3 years, and 5 years was 96.3%, 90.6%, 82.5%, and 79.4% in the non-reoperation group and 95.9%, 82.7%, 72.8% and 69.3% in the reoperation group, respectively. Patient survival in the reoperation group was significantly lower than that in the non-reoperation group (P=0.018). In the reoperation group, the survival rates of patients with GI tract-related complications?including bile leakage and GI tract complications?were significantly worse than those of patients with non-GI tract-related complications such as bleeding, vascular complications, and wound complications (P<0.001).

Conclusions: Our results showed that patient outcomes are poor after early reoperation after LDLT and that patients with GI tract-related complications have a higher risk of mortality.

키워드

Living donors; Liver transplantation; Postoperative complications; Reoperation
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