Yoeli Dor, Ackah Ruth L, Sigireddi Rohini R, Kueht Michael L, Galvan N Thao N, Cotton Ronald T, Rana Abbas, O'Mahony Christine A, Goss John A
Michael E. DeBakey Department of Surgery, Division of Abdominal Transplantation, Baylor College of Medicine and Texas Children's Hospital, Houston, TX, USA.
Michael E. DeBakey Department of Surgery, Division of Abdominal Transplantation, Baylor College of Medicine and Texas Children's Hospital, Houston, TX, USA.
J Pediatr Surg. 2018 Nov;53(11):2240-2244. doi: 10.1016/j.jpedsurg.2018.04.001. Epub 2018 Apr 7.
The aim of this study is to describe the incidence and impact of reoperation following pediatric liver transplantation, as well as the indications and risk factors for these complications.
All primary pediatric liver transplants performed at our institution between January 2012 and September 2016 were reviewed. A reoperative complication was defined as a complication requiring return to the operating room within 30 days or the same hospital admission as the transplant operation, excluding retransplantation.
Among the 144 pediatric liver transplants performed during the study period, 9% of the recipients required reoperation. The most common indications for reoperation were bleeding and bowel complications. There was no significant difference in the graft survival of patients with a reoperation and those without a reoperation (p = 0.780), but patients with a reoperation had a significantly longer hospital length of stay (median of 39 days vs. 11 days, p = 0.001). Variant donor arterial anatomy, transplant operative time, intraoperative blood loss, transfusion volume of packed red blood cells or cell saver per weight, and transfusion with fresh frozen plasma, platelets, or cryoprecipitate were significantly associated with reoperation upon univariable logistic regression, but none of these risk factors remained statistically significant upon multivariable regression.
At our institution, reoperation did not significantly impact graft survival. We identified variant donor arterial anatomy, transplant operative time, intraoperative blood loss, transfusion volume of packed red blood cells or cell saver per weight, and transfusion with fresh frozen plasma, platelets, or cryoprecipitate as risk factors for reoperation, although none of these risk factors demonstrated independent association with reoperation in a multivariable model.
Prognosis Study.
Level III.
本研究旨在描述小儿肝移植术后再次手术的发生率和影响，以及这些并发症的指征和危险因素。
回顾了2012年1月至2016年9月在我院进行的所有小儿初次肝移植手术。再次手术并发症定义为在移植手术30天内或同一住院期间需要返回手术室的并发症，不包括再次移植。
在研究期间进行的144例小儿肝移植中，9%的受者需要再次手术。再次手术最常见的指征是出血和肠道并发症。再次手术患者与未再次手术患者的移植物存活率无显著差异（p = 0.780），但再次手术患者的住院时间明显更长（中位数为39天对11天，p = 0.001）。在单因素逻辑回归中，供体动脉解剖变异、移植手术时间、术中失血、每体重单位的浓缩红细胞或细胞回收器输血量以及新鲜冰冻血浆、血小板或冷沉淀输血与再次手术显著相关，但在多因素回归中，这些危险因素均无统计学意义。
在我院，再次手术对移植物存活率无显著影响。我们确定供体动脉解剖变异、移植手术时间、术中失血、每体重单位的浓缩红细胞或细胞回收器输血量以及新鲜冰冻血浆、血小板或冷沉淀输血是再次手术的危险因素，尽管在多变量模型中这些危险因素均未显示与再次手术有独立关联。
预后研究。
三级。
