Department of HPB Surgery and Liver Transplantation, Shifa International Hospital Islamabad, Sector H-8/4, Islamabad, Pakistan.
Department of HPB Surgery and Liver Transplantation, Shifa International Hospital Islamabad, Sector H-8/4, Islamabad, Pakistan.
Int J Surg. 2017 Aug;44:281-286. doi: 10.1016/j.ijsu.2017.07.026. Epub 2017 Jul 8.
As a quality assessment tool, failure to rescue (FTR) has been employed in various surgical specialties. However, its role in liver transplantation has only recently been explored. To the best of our knowledge, role of FTR in living donor liver transplant (LDLT) has not been assessed previously. The objective of the current study was to determine failure to rescue (FTR) rate and it's predictors in an LDLT center.
We reviewed a prospectively maintained database of patients who underwent LDLT at our center between 2012 and 2016. Patients who experienced grade 3B or above complications on Clavien-Dindo grading were included in this study. Primary outcome of interest was FTR rate in these patients. FTR was defined as a preventable major complication followed by death within one year after transplantation. We also looked at independent predictors of FTR in our patients and a multivariate analysis was performed.
Median age was 48.4(18-73) years. Male to female ratio was 3.3:1. Median MELD score was 17(6-42). The FTR rate in the current study was 52/131 (39.6%). Infectious complications were more common in the FTR group i.e. 22/32(68.8%) versus 10/32 (31.2%) (P < 0.0001). Biliary complications were more common in the non-FTR group i.e. 49/62 (79.1%) versus 13/62 (20.9%) (P < 0.0001). On multivariate analysis, there was a 60% increase in mortality following a major complication in the presence of early allograft dysfunction (Hazard ratio: 1.6, Confidence interval; 1.2-2.2, P = 0.002). A 40% reduction in FTR was seen in patients with a biliary complication versus other complications (Hazard ratio: 0.6, Confidence interval = 0.4-0.8, P = 0.009).
Early allograft dysfunction and biliary complications are independent predictors of FTR in LDLT.
作为一种质量评估工具，失败抢救（FTR）已被应用于各种外科专业。然而，它在肝移植中的作用最近才被探索。据我们所知，FTR 在活体供肝移植（LDLT）中的作用以前尚未得到评估。本研究的目的是确定在 LDLT 中心的 FTR 发生率及其预测因素。
我们回顾了 2012 年至 2016 年期间在我们中心接受 LDLT 的患者的前瞻性维护数据库。在 Clavien-Dindo 分级中发生 3B 级或以上并发症的患者被纳入本研究。本研究的主要观察结果是这些患者的 FTR 发生率。FTR 定义为可预防的主要并发症，随后在移植后 1 年内死亡。我们还观察了我们患者的独立预测因素，并进行了多变量分析。
中位年龄为 48.4（18-73）岁。男女比例为 3.3:1。中位 MELD 评分为 17（6-42）。本研究的 FTR 发生率为 52/131（39.6%）。FTR 组感染并发症更为常见，即 22/32（68.8%）与 10/32（31.2%）（P<0.0001）。FTR 组非 FTR 组的胆道并发症更为常见，即 49/62（79.1%）与 13/62（20.9%）（P<0.0001）。多变量分析显示，在存在早期移植物功能障碍的情况下，主要并发症后死亡率增加 60%（风险比：1.6，置信区间：1.2-2.2，P=0.002）。胆道并发症患者的 FTR 降低 40%，而其他并发症患者的 FTR 降低 40%（风险比：0.6，置信区间=0.4-0.8，P=0.009）。
早期移植物功能障碍和胆道并发症是 LDLT 中 FTR 的独立预测因素。
