TY - JOUR
T1 - Surgical complications after living and deceased donor liver transplant
T2 - The NSQIP transplant experience
AU - Amara, Dominic
AU - Parekh, Justin
AU - Sudan, Debra
AU - Elias, Nahel
AU - Foley, David P.
AU - Conzen, Kendra
AU - Grieco, Arielle
AU - Braun, Hillary J.
AU - Greenstein, Stuart
AU - Byrd, Claudia
AU - Ko, Clifford
AU - Hirose, Ryutaro
N1 - Funding Information:
None to disclose.
Publisher Copyright:
© 2022 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.
PY - 2022/6
Y1 - 2022/6
N2 - This study used the prospective National Surgical Quality Improvement Program (NSQIP) Transplant pilot database to analyze surgical complications after liver transplantation (LT) in LT recipients from 2017to 2019. The primary outcome was surgical complication requiring intervention (Clavien-Dindo grade II or greater) within 90 days of transplant. Of the 1684 deceased donor and 109 living donor LT cases included from 29 centers, 38% of deceased donor liver recipients and 47% of living donor liver recipients experienced a complication. The most common complications included biliary complications (19% DDLT; 31% LDLT), hemorrhage requiring reoperation (14% DDLT; 9% LDLT), and vascular complications (6% DDLT; 9% LDLT). Management of biliary leaks (35.3% ERCP, 38.0% percutaneous drainage, 26.3% reoperation) and vascular complications (36.2% angioplasty/stenting, 31.2% medication, 29.8% reoperation) was variable. Biliary (aHR 5.14, 95% CI 2.69–9.8, P <.001), hemorrhage (aHR 2.54, 95% CI 1.13–5.7, P =.024) and vascular (aHR 2.88, 95% CI.85–9.7, P =.089) complication status at 30-days post-transplant were associated with lower 1-year patient survival. We conclude that biliary, hemorrhagic and vascular complications continue to be significant sources of morbidity and mortality for LT recipients. Understanding the different risk factors for complications between deceased and living donor liver recipients and standardizing complication management represent avenues for continued improvement.
AB - This study used the prospective National Surgical Quality Improvement Program (NSQIP) Transplant pilot database to analyze surgical complications after liver transplantation (LT) in LT recipients from 2017to 2019. The primary outcome was surgical complication requiring intervention (Clavien-Dindo grade II or greater) within 90 days of transplant. Of the 1684 deceased donor and 109 living donor LT cases included from 29 centers, 38% of deceased donor liver recipients and 47% of living donor liver recipients experienced a complication. The most common complications included biliary complications (19% DDLT; 31% LDLT), hemorrhage requiring reoperation (14% DDLT; 9% LDLT), and vascular complications (6% DDLT; 9% LDLT). Management of biliary leaks (35.3% ERCP, 38.0% percutaneous drainage, 26.3% reoperation) and vascular complications (36.2% angioplasty/stenting, 31.2% medication, 29.8% reoperation) was variable. Biliary (aHR 5.14, 95% CI 2.69–9.8, P <.001), hemorrhage (aHR 2.54, 95% CI 1.13–5.7, P =.024) and vascular (aHR 2.88, 95% CI.85–9.7, P =.089) complication status at 30-days post-transplant were associated with lower 1-year patient survival. We conclude that biliary, hemorrhagic and vascular complications continue to be significant sources of morbidity and mortality for LT recipients. Understanding the different risk factors for complications between deceased and living donor liver recipients and standardizing complication management represent avenues for continued improvement.
KW - clinical quality registry
KW - liver transplant complication management
KW - liver transplant complications
KW - quality improvement
KW - surgical complications
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U2 - 10.1111/ctr.14610
DO - 10.1111/ctr.14610
M3 - Article
C2 - 35143698
AN - SCOPUS:85129296878
SN - 0902-0063
VL - 36
JO - Clinical Transplantation
JF - Clinical Transplantation
IS - 6
M1 - e14610
ER -