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Original Article

Korean J Transplant 2019; 33(4): 128-134

Published online December 31, 2019

https://doi.org/10.4285/jkstn.2019.33.4.128

© The Korean Society for Transplantation

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

Manuel Lim, Jinsoo Rhu, Sangjin Kim, Seohee Lee, Jong Man Kim, Gyu-Seong Choi, Jae-Won Joh

Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea

Correspondence to: Jong Man Kim
Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Korea
Tel: +82-2-3410-1719, Fax: +82-2-3410-0040 E-mail: yjongman21@gmail.com

Received: October 2, 2019; Revised: December 6, 2019; Accepted: December 19, 2019

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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.

Keywords: Living donors, Liver transplantation, Postoperative complications, Reoperation