Impact of early reoperation following living-donor liver transplantation on graft survival

Yoshikuni Kawaguchi; Yasuhiko Sugawara; Nobuhisa Akamatsu; Junichi Kaneko; Tsuyoshi Hamada; Tomohiro Tanaka; Takeaki Ishizawa; Sumihito Tamura; Taku Aoki; Yoshihiro Sakamoto; Kiyoshi Hasegawa; Norihiro Kokudo

doi:10.1371/journal.pone.0109731

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Impact of early reoperation following living-donor liver transplantation on graft survival

Journal article

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Impact of early reoperation following living-donor liver transplantation on graft survival

Yoshikuni Kawaguchi, Yasuhiko Sugawara, Nobuhisa Akamatsu, Junichi Kaneko, Tsuyoshi Hamada, Tomohiro Tanaka, Takeaki Ishizawa, Sumihito Tamura, Taku Aoki, Yoshihiro Sakamoto, …

PloS one, Vol.9(11), pp.e109731-e109731

2014

DOI: 10.1371/journal.pone.0109731

PMCID: PMC4232253

PMID: 25396413

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Abstract

The reoperation rate remains high after liver transplantation and the impact of reoperation on graft and recipient outcome is unclear. The aim of our study is to evaluate the impact of early reoperation following living-donor liver transplantation (LDLT) on graft and recipient survival. Recipients that underwent LDLT (n = 111) at the University of Tokyo Hospital between January 2007 and December 2012 were divided into two groups, a reoperation group (n = 27) and a non-reoperation group (n = 84), and case-control study was conducted. Early reoperation was performed in 27 recipients (24.3%). Mean time [standard deviation] from LDLT to reoperation was 10 [9.4] days. Female sex, Child-Pugh class C, Non-HCV etiology, fulminant hepatitis, and the amount of intraoperative fresh frozen plasma administered were identified as possibly predictive variables, among which females and the amount of FFP were identified as independent risk factors for early reoperation by multivariable analysis. The 3-, and 6- month graft survival rates were 88.9% (95%confidential intervals [CI], 70.7-96.4), and 85.2% (95%CI, 66.5-94.3), respectively, in the reoperation group (n = 27), and 95.2% (95%CI, 88.0-98.2), and 92.9% (95%CI, 85.0-96.8), respectively, in the non-reoperation group (n = 84) (the log-rank test, p = 0.31). The 12- and 36- month overall survival rates were 96.3% (95%CI, 77.9-99.5), and 88.3% (95%CI, 69.3-96.2), respectively, in the reoperation group, and 89.3% (95%CI, 80.7-94.3) and 88.0% (95%CI, 79.2-93.4), respectively, in the non-reoperation group (the log-rank test, p = 0.59). Observed graft survival for the recipients who underwent reoperation was lower compared to those who did not undergo reoperation, though the result was not significantly different. Recipient overall survival with reoperation was comparable to that without reoperation. The present findings enhance the importance of vigilant surveillance for postoperative complication and surgical rescue at an early postoperative stage in the LDLT setting.

Multivariate Analysis

Reoperation

Liver Transplantation

Humans

Middle Aged

Risk Factors

Proportional Hazards Models

Survival Analysis

Female

Graft Survival

Male

Living Donors

Details

Title: Subtitle: Impact of early reoperation following living-donor liver transplantation on graft survival
Creators: Yoshikuni Kawaguchi - Artificial Organ and Transplantation Surgery Division, Department of Surgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
Yasuhiko Sugawara - Artificial Organ and Transplantation Surgery Division, Department of Surgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
Nobuhisa Akamatsu - Artificial Organ and Transplantation Surgery Division, Department of Surgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
Junichi Kaneko - Artificial Organ and Transplantation Surgery Division, Department of Surgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
Tsuyoshi Hamada - Department of Gastroenterology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
Tomohiro Tanaka - Organ Transplantation Service, University of Tokyo, Tokyo, Japan
Takeaki Ishizawa - Artificial Organ and Transplantation Surgery Division, Department of Surgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
Sumihito Tamura - Artificial Organ and Transplantation Surgery Division, Department of Surgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
Taku Aoki - Artificial Organ and Transplantation Surgery Division, Department of Surgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
Yoshihiro Sakamoto - Artificial Organ and Transplantation Surgery Division, Department of Surgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
Kiyoshi Hasegawa - Artificial Organ and Transplantation Surgery Division, Department of Surgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
Norihiro Kokudo - Artificial Organ and Transplantation Surgery Division, Department of Surgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
Resource Type: Journal article
Publication Details: PloS one, Vol.9(11), pp.e109731-e109731
DOI: 10.1371/journal.pone.0109731
PMID: 25396413
PMCID: PMC4232253
NLM abbreviation: PLoS One
ISSN: 1932-6203
eISSN: 1932-6203
Publisher: Public Library of Science
Language: English
Date published: 2014
Academic Unit: Gastroenterology and Hepatology; Internal Medicine
Record Identifier: 9984094614002771

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