Abstract
Background
Recipient hepatectomy during liver transplantation can be a challenging operation and can increase cold ischaemic time. The aim of this study is to assess factors associated with prolonged recipient hepatectomy.
Methods
From 2005 to 2015, 930 patients were submitted to liver transplantation in our hospital. Prolonged hepatectomy time was defined as operative time >180 min (from knife on skin to total hepatectomy). Patients undergoing early liver retransplantation and living donation were excluded.
Results
A total of 715 patients were included in our study. Median age at transplantation was 53 (18–70) years, and median BMI was 26.2 (16–40). Median hepatectomy time was 131 min. Prolonged hepatectomy time occurred in 89 (12.4%) patients. At univariate analysis, previous decompensated cirrhosis with variceal bleeding and/or ascites, higher BMI and previous abdominal surgery were associated with prolonged operating time. Higher surgeon experience and acute liver failure were associated with shorter hepatectomy time. At multivariate analysis, previous episodes of variceal bleeding (p = 0.027, OR 1.78), BMI > 27 (p = 0.01, OR 1.75), previous abdominal surgery (p = 0.04, OR 1.68) and surgeon experience (p = 0.007, OR 2.04) were independently associated with operating time. Prolonged hepatectomy time was significantly associated with cold and total ischaemic time and intraoperative bleeding (p < 0.001, p = 0.002 and p = 0.002, respectively).
Conclusions
Recipient BMI, previous episodes of variceal bleeding, previous abdominal surgery and surgeon experience are independently associated with hepatectomy duration. These factors can be helpful to identify those patients with potentially prolonged hepatectomy time, and therefore, strategies can be put in place to optimize outcomes in this group of patients.
Similar content being viewed by others
References
Burroughs AK, Sabin CA, Rolles K et al (2006) 3-month and 12-month mortality after first liver transplant in adults in Europe: predictive models for outcome. Eur Liver Transp Assoc Lancet 367(9506):225–232
Lladó L, Figueras J (2004) Techniques of orthotopic liver transplantation. HPB (Oxford) 6(2):69–75
Piardi T, Lhuaire M, Bruno O et al (2016) Vascular complications following liver transplantation: a literature review of advances in 2015. World J Hepatol 8(1):36–57
Feltracco P, Brezzi ML, Barbieri S et al (2013) Blood loss, predictors of bleeding, transfusion practice and strategies of blood cell salvaging during liver transplantation. World J Hepatol 5(1):1–15
Stahl JE, Kreke JE, Malek FA et al (2008) Consequences of cold-ischemia time on primary nonfunction and patient and graft survival in liver transplantation: a meta-analysis. PLoS ONE 3(6):e2468
He J, Liu H, Deng L et al (2019) Influence of obesity on in-hospital and postoperative outcomes of hepatic resection for malignancy: a 10-year retrospective analysis from the US National Inpatient Sample. BMJ Open 9(8):e029823
McHugh PP, Shah SH, Johnston TD et al (2010) Predicting dry weight in patients with ascites and liver cirrhosis using computed tomography imaging. Hepatogastroenterology 57(99–100):591–597
Race ND, Groszmann RJ, Garcia-Tsao G et al (1998) Portal hypertension and variceal bleeding: an AASLD single topic symposium. Hepatology 28(3):868–880
Hackl C, Schlitt HJ, Renner P et al (2016) Liver surgery in cirrhosis and portal hypertension. World J Gastroenterol 22(9):2725–2735
Davila D, Bartlett A, Heaton N (2008) Temporary portocaval shunt in orthotopic liver transplantation: need for a standardized approach? Liver Transpl 14(10):1414–1419
Silva JP, Berger NG, Yin Z et al (2018) The effect of prior upper abdominal surgery on outcomes after liver transplantation for hepatocellular carcinoma: an analysis of the database of the organ procurement transplant network. Surgery 163(5):1028–1034
Jochmans I, Fieuws S, Tieken I et al (2018) The impact of implantation time during liver transplantation on outcome: a Eurotransplant cohort study. Transpl Direct 4(6):e356
Kawaguchi Y, Hasegawa K, Tzeng CD et al (2020) Performance of a modified three-level classification in stratifying open liver resection procedures in terms of complexity and postoperative morbidity. Br J Surg 107(3):258–267
Jang JS, Cho JY, Ahn S et al (2018) Comparative performance of the complexity classification and the conventional major/minor classification for predicting the difficulty of liver resection for hepatocellular carcinoma. Ann Surg 267(1):18–23
Pan ET, Yoeli D, Galvan NTN et al (2018) Cold ischemia time is an important risk factor for post-liver transplant prolonged length of stay. Liver Transpl 24(6):762–768
Sibulesky L, Li M, Hansen RN et al (2016) Impact of cold ischemia time on outcomes of liver transplantation: a single center experience. Ann Transpl 21:145–151
Cleland S, Corredor C, Ye JJ et al (2016) Massive haemorrhage in liver transplantation: consequences, prediction and management. World J Transpl 6(2):291–305
Rana A, Petrowsky H, Hong JC et al (2013) Blood transfusion requirement during liver transplantation is an important risk factor for mortality. J Am Coll Surg 216(5):902–907
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
Authors declare no conflicts of interests or disclosures.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Ausania, F., Al Shwely, F., Farguell, J. et al. Factors Associated with Prolonged Recipient Hepatectomy Time During Liver Transplantation: A Single-Centre Experience. World J Surg 44, 3486–3490 (2020). https://doi.org/10.1007/s00268-020-05643-7
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00268-020-05643-7