Impacts on Outcomes of Early Unplanned Abdominal Reoperation Following Liver Transplantation: An Audit From a Single-center Experience

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BACKGROUND: The present study analyzes the complications requiring unplanned abdominal reoperation (Early Unplanned Reoperation [EUReop]) following liver transplantation (LT), its impact on short- and long-term outcomes, and identifies its predictors. METHODS: A single-center retrospective analysis including all consecutive adult LT performed from 2007 to 2018. The impact of EUReop on 90-d mortality was assessed using multivariate analysis, and the failure to rescue (FTR) after EUReop was evaluated. Long-term outcomes were assessed using Kaplan-Meier curves. Predictors of EUReop were identified through multivariate logistic regression. RESULTS: Among 1213 LT, 203 patients (17%) required EUReop within a median of 6 d. The leading causes were bleeding (n = 114, 56%), arterial (n = 24, 12%), wound disruption or collection (n = 14, 7%), and biliary complications (n = 12, 6%). Independent predictors of EUReop included intensive care unit admission at LT (adjusted odds ratio: 3.0 [95% confidence interval, 1.7-5.7]), portal vein thrombosis (2.6 [1.5-4.2]), partial liver graft (1.8 [1.0-3.2]), hospitalization at LT (1.7 [1.1-2.7]), inferior vena cava replacement (1.7 [1.1-2.7]), elective re-LT (1.7 [1.0-2.8]), transfusion ≥4 units of red blood cells (1.7 [1.1-2.6]). FTR rate following EUReop was 12%, associated with Balance of Risk score and higher transfusion requirements during LT. The FTR rate significantly decreased over the study period. EUReop was an independent predictor of 90-d mortality (adjusted odds ratios 2.6 [1.4-4.6]). Patients with EUReop exhibited significantly decreased 1-, 3-, and 5-y patient and graft survival rates. CONCLUSIONS: EUReop following LT remains frequent. It is associated with increased 90-d mortality and compromised long-term survival. Patients at risk for EUReop exhibit higher pre-LT acuity and surgical complexity.

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