Risk of Reoperation Within 90 Days of Liver Transplantation: A Necessary Evil?

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• 作者：Audrey E. Ertel ; MD ; MS^a ; ^b ; Koffi Wima ; MS^a ; ^b ; Alex L. Chang ; MD^a ; ^b ; Richard S. Hoehn ; MD^a ; ^b ; Samual F. Hohmann ; PhD^c ; ^d ; Michael J. Edwards ; MD ; FACS^a ; ^b ; Daniel E. Abbott ; MD ; FACS^a ; ^b ; Shimul A. Shah ; MD ; MHCM ; FACS^a ; ^b ; ^{Shimul.shah@uc.edu" class="auth_mail" title="E-mail the corresponding author}
• 关键词：LT ; liver transplantation ; MELD ; Model for End-Stage Liver Disease ; SRTR ; Scientific Registry of Transplant Recipients ; UHC ; University HealthSystem Consortium
• 刊名：Journal of the American College of Surgeons
• 出版年：2016
• 出版时间：April 2016
• 年：2016
• 卷：222
• 期：4
• 页码：419-428
• 全文大小：471 K

文摘

The rate and consequences of reoperation after liver transplantation (LT) are unknown in the United States.

Study Design

Adult patients (n = 10,295; 45% of all LT) undergoing LT from 2009 through 2012 were examined using a linkage of the University HealthSystem Consortium and Scientific Registry of Transplant Recipients databases providing recipient, donor, center, hospitalization, and survival details. Median follow-up was 2 years. Reoperations were identified within 90 days after LT.

Results

Overall 90-day reoperation rate after LT was 29.3%. Risk factors for 90-day reoperation included recipients with a history of hemodialysis, severely ill functional status, government insurance, increasing Model for End-Stage Liver Disease score, and increasing donor risk index. Reoperation within 90 days was found to be an independent predictor of adjusted 1-year mortality (odds ratio = 1.8; 95% CI, 1.5–2.1), as was government-provided insurance and increasing donor risk index. Additionally, patients undergoing delayed reoperative intervention (after 30 days) were found to have increased risk of 1-year mortality compared with those undergoing early reoperative intervention (odds ratio = 1.96; 95% CI, 1.4–2.7; p < 0.01).

Conclusions

This is the first national study reporting that nearly one-third of transplant recipients undergo reoperation within 90 days of LT. Although necessary at times, reoperation is associated with increased risk of death at 1 year; however, it appears that the timing of these interventions can be critical, due to the type of intervention required. Early reoperative intervention does not appear to influence long-term outcomes, and delayed intervention (after 30 days) is strongly associated with decreased survival.