Department of General Surgery, Faculty of Medicine, İnönü University, Malatya, Turkiye.
Department of Gastroenterology Surgery, Eskişehir State Hospital, Eskişehir, Turkiye.
Turk J Med Sci. 2024 Jun 6;54(5):881-886. doi: 10.55730/1300-0144.5863. eCollection 2024.
BACKGROUND/AIM: Despite advancements in surgical methodologies and the extensive perioperative and postoperative care administered to recipients, the prevalence of complications requiring early relaparotomy following living donor liver transplantation (LDLT) remains persistent. This study sought to analyze the determinants influencing relaparotomy occurrences in the initial 30 days following LDLT. Additionally, it was aimed to evaluate the impact of early laparotomy on both graft and patient survival within this distinct patient cohort.
The study encompassed recipients (n = 535) aged 18 years and older who underwent primary LDLT at our institution from January 2019 to December 2021. Exclusion criteria involved patients necessitating early retransplantation. Early relaparotomy was specified as surgical intervention within the initial 30 days following LDLT.
The study enrolled a total of 535 patients, among whom 85 (15.9%) underwent early relaparotomy. The median age of the patients was 54 (range: 41-60) years, with a predominant male representation (66.2%). Univariate analysis comparing the laparotomy and nonrelaparotomy groups revealed statistically significant differences in the creatinine (p = 0.043) and sodium (p = 0.025) levels, graft side (p < 0.001), etiology (p = 0.005), and blood loss (p = 0.012).In the multivariate analysis, creatinine (p = 0.039; OR = 1.668; 95% CI = 1.027-2.709) and left lobe graft (p < 0.0001; OR = 3.611; 95% CI = 1.960-6.652) emerged as independent risk factors for relaparotomy.
The primary causes of early relaparotomy following LDLT include postoperative bleeding, biliary leakage, and vascular complications. Preoperative elevation in creatinine and sodium levels, the presence of Budd-Chiari syndrome, utilization of a left lobe graft, and intraoperative blood loss are identified as risk factors associated with early relaparotomy after LDLT. Patients undergoing early relaparotomy exhibit inferior survival rates compared to those who do not.
背景/目的：尽管手术方法不断进步，受者围手术期和术后护理也得到了广泛的加强，但活体肝移植（LDLT）后需要早期再次剖腹手术的并发症发生率仍然居高不下。本研究旨在分析影响 LDLT 后 30 天内再次剖腹手术的决定因素。此外，还旨在评估在这一特定患者群体中，早期剖腹手术对移植物和患者生存的影响。
该研究纳入了 2019 年 1 月至 2021 年 12 月在我院接受初次 LDLT 的年龄在 18 岁及以上的受者（n=535）。排除标准包括需要早期再次移植的患者。早期再次剖腹手术定义为 LDLT 后 30 天内的手术干预。
该研究共纳入 535 例患者，其中 85 例（15.9%）进行了早期再次剖腹手术。患者的中位年龄为 54 岁（范围：41-60 岁），以男性为主（66.2%）。对剖腹手术组和非剖腹手术组进行单因素分析显示，肌酐（p=0.043）和钠（p=0.025）水平、供肝侧（p<0.001）、病因（p=0.005）和出血量（p=0.012）存在统计学差异。多因素分析显示，肌酐（p=0.039；OR=1.668；95%CI=1.027-2.709）和左外叶供肝（p<0.0001；OR=3.611；95%CI=1.960-6.652）是再次剖腹手术的独立危险因素。
LDLT 后早期再次剖腹手术的主要原因包括术后出血、胆漏和血管并发症。术前肌酐和钠水平升高、布加综合征、使用左外叶供肝以及术中出血量被确定为 LDLT 后早期再次剖腹手术的相关危险因素。与未进行早期再次剖腹手术的患者相比，进行早期再次剖腹手术的患者生存率较低。
