Cell and Organ Transplantology. 2014; 2(2):122-126.
Treatment of the early postoperative complications following liver transplantation
Rummo O. O.
Republican Scientific Practical Center for Organ and Tissue Transplantation, Minsk, Belarus
Despite considerable reduction of the lethality rate after ortotopic liver transplantation and owing to the achievements in modern surgery, immunology and anesthesiology, the early postoperative complications still occur in nearly 70 % and can significantly compromise patient survival.
The aim of this study was to assess the frequency and causes of early post-transplantation complications and to develop effective means for their prophylaxis and treatment.
Materials and methods. Within the period from 03.04.2008 to 01.07.2014, altogether 260 liver transplantations were performed in 252 recipients in the Republican Center for organ and tissue transplantation (Minsk, Belarus: of them 209 (81.2 %) according to the classic technique, 46 (17.7 %) cavaplasty and 5 portal transposition (2.4 %).
Thirty-six liver transplantations (13.9 %) were performed in children before 18 years of age. The strategy of peri-operative techniques and immune-suppressive therapy were the same for all patients.
Results. Vascular complications occurred in 44 cases (16.9 %), biliary complications in 46 (17.7 %), acute kidney injury in 47 (18.1 %), primary non-functioning after 3 liver transplantations (1.2 %), early allograft dysfunction in 71 (27.3 %) cases, and bacterial complications after 66 (25.4 %) liver transplantations. Predictors of early allograft dysfunction were thermal ischemia and graft steatosis. Three-year patients’ survival was 85 %.
Conclusion. The main cause of death was multiple organ failure developed in a sign of bacterial complications and early allograft dysfunction. Significant role in early postoperative complications prophylaxis acts interdisciplinary prevention of nosocomial infection.
Keywords: liver transplantation; early postoperative complications; macrovesicular steatosis; warm ischemia timeFull Text PDF
|1. Amin MG, Wolf MP, TenBrook JA, et al. Expanded criteria donor grafts for deceased donor liver transplantation under the MELD system: a decision analysis. Liver Transpl. 2004; 10(12):1468-1475.
|2. Mueller AR, Platz KP, Kremer B. Early postoperative complications following liver transplantation. Best Practice & Research Clinical Gastroenterology. 2004; 18(5):881–900.
|3. Baccarani U, Rossetto A, Lorenzin D, et al. Protection of the intrahepatic biliary tree by contemporaneous portal and arterial reperfusion: results of a prospective randomized pilot study. Updates Surg. 2012; 64(3):173-7.
|4. Cameron AM, Ghobrial RM, Yersiz H, et al. Optimal utilization of donor grafts with extended criteria: a single-center experience in over 1000 liver transplants. Ann Surg. 2006; 243(6):748-753.
|5. Clavien PA. Sinusoidal endothelial cell injury during hepatic preservation and reperfusion. Hepatology 1998; 28:281-285.
|6. Nüssler NC, Settmacher U, Haase R, et al. Diagnosis and Treatment of Arterial Steal Syndromes in Liver Transplant Recipients. Liver Transplantation. 2003; 9(6):596-602.
|7. Gurusamy KS, Naik P, Abu-Amara M, et al. Techniques of reperfusion for liver transplantation. The Cochrane Library. 2013; 3: http//www.thecochranelibrary.com.|
|8. Kundakci A, Pirat A, Komurcu O, et al. Rifle criteria for acute kidney dysfunction following liver transplantation: incidence and risk factors. Transplant Proc; 2010; 42(10):4171-4.
|9. Manzini, G.; Kremer, M.; Houben, P, et al. Reperfusion of liver graft during transplantation: techniques used in transplant centres within Eurotransplant and meta-analysis of the literature. Transpl Int. 2013; 26 (5):508-516.
|10. Olthoff KM, Kulik L, Samstein B, et al. Validation of a current definition of early allograft dysfunction in liver transplant recipients and analysis of risk factors. Liver Transplantation. 2010; 16(8):943-949.
|11. Puhl G, Schaser KD, Pust D, et al. The delay of rearterialization after initial portal reperfusion in living donor liver transplantation significantly determines the development of microvascular graft dysfunction. J Hepatol. 2004; 41(2):299-306.
|12. Busuttil RW, Tanaka K. The Utility of Marginal Donors in Liver Transplantation. Liver Transplantation. 2003; 9(7):651-663.
|13. Rubin RH. The direct and indirect effects of infection in liver transplantation: pathogenesis, impact, and clinical management. Curr Clin Top Infect Dis. 2002; 22:125-54.
|14. Saner FH, Olde Damink SW, Pavlakovic G, et al. Pulmonary and blood stream infections in adult living donor and cadaveric liver transplant patients. Transplantation 2008; 85:1564-8.
|15. Song AT, Avelino-Silva VI, Pecora RA, et al. Liver transplantation: Fifty years of experience. World J Gastroenterol. 2014; 20(18):5363-5374.
Rummo OO. Тreatment of the early postoperative complications following liver transplantation. Cell and Organ Transplantology. 2014; 2(2):122-126. doi: 10.22494/COT.V2I2.33