Nejatollahi Seyed Mohammad Reza, Nazari Maryam, Mostafavi Keihan, Ghorbani Fariba
Hepato-Pancreato-Biliary and Transplant Surgery, Masih Daneshvari Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Lung Transplantation Research Center, National Research Institute of Tuberculosis and Lung Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Korean J Transplant. 2023 Jun 30;37(2):103-108. doi: 10.4285/kjt.23.0026.
Liver transplantation (LT) is widely recognized as a life-saving therapy for patients with end-stage liver disease. However, due to certain posttransplant complications, reoperations or endovascular interventions may be necessary to improve patient outcomes. This study was conducted to examine reasons for reoperation during the initial hospital stay following LT and to identify its predictive factors.
We evaluated the incidence and etiology of reoperation in 133 patients who underwent LT from brain-dead donors over a 9-year period based on our experiences.
A total of 52 reoperations were performed for 29 patients, with 17 patients requiring one reoperation, seven requiring two, three requiring three, one requiring four, and one requiring eight. Four patients underwent liver retransplantation. The most common cause of reoperation was intra-abdominal bleeding. Hypofibrinogenemia was identified as the sole predisposing factor for bleeding. Frequencies of comorbidities such as diabetes mellitus and hypertension did not differ significantly between groups. Among patients who underwent reoperation due to bleeding, the mean plasma fibrinogen level was 180.33±68.21 mg/dL, while among reoperated patients without bleeding, it was 240.62±105.14 mg/dL (P=0.045; standard mean difference, 0.61; 95% confidence interval, 0.19-1.03). The initial hospital stay was significantly longer for the reoperated group (47.5±15.5 days) than for the non-reoperated group (22.5±5.5 days).
Meticulous pretransplant assessment and postoperative care are essential for the early identification of predisposing factors and posttransplant complications. In order to enhance graft and patient outcomes, any complications should be addressed without hesitation, and appropriate intervention or surgery should not be delayed.
肝移植（LT）被广泛认为是终末期肝病患者的一种挽救生命的治疗方法。然而，由于某些移植后并发症，可能需要再次手术或血管内介入治疗以改善患者预后。本研究旨在探讨肝移植术后初次住院期间再次手术的原因，并确定其预测因素。
根据我们的经验，评估了133例接受脑死亡供体肝移植患者在9年期间再次手术的发生率和病因。
29例患者共进行了52次再次手术，其中17例患者需要进行1次再次手术，7例需要2次，3例需要3次，1例需要4次，1例需要8次。4例患者接受了再次肝移植。再次手术最常见的原因是腹腔内出血。低纤维蛋白原血症被确定为出血的唯一易感因素。糖尿病和高血压等合并症的发生率在两组之间没有显著差异。在因出血而接受再次手术的患者中，血浆纤维蛋白原平均水平为180.33±68.21mg/dL，而在未出血的再次手术患者中，血浆纤维蛋白原平均水平为240.62±105.14mg/dL（P = 0.045；标准平均差，0.61；95%置信区间，0.19 - 1.03）。再次手术组的初次住院时间（47.5±15.5天）明显长于未再次手术组（22.5±5.5天）。
细致的移植前评估和术后护理对于早期识别易感因素和移植后并发症至关重要。为了提高移植物和患者的预后，应毫不犹豫地处理任何并发症，不应延迟适当的干预或手术。
