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[Complications in 52 liver transplantations excluding graft rejection]
S Bresson-Hadni1, P Guerzider, J P Miguet
1Service d'Hépatologie, Hôpital Jean Minjoz, CHU de Besançon.
Abstract:
We analyzed the postoperative complications excluding graft rejection in 52 consecutive orthotopic liver transplantations performed from March 1986 to November 1988 in 48 patients. Thirteen patients died: one intraoperatively, seven during the first 2 months, and five between 5 and 28 months. Complications were predominant during the first 3 months; infection was the most common complication. The main cause was viral agents. Cytomegalovirus was responsible for infection in 62 percent of cases, but was symptomatic in only 37 percent of patients and always had a favorable outcome. Six cases of disseminated candidiasis were observed with fatal outcome in 3 cases. Ten patients had septicemia due to Gram positive germs with a favorable course in all cases. Two patients required retransplantation on the 2nd postoperative day because of primary graft failure. Three patients had hepatic infarction which was fatal in one case. Technical complications were represented by intra-abdominal bleeding in 3 cases, perihepatic hematoma in 10 cases and stenosis of the biliary anastomosis in 8 cases; in one patient, partial portal vein thrombosis occurred; no hepatic arterial thrombosis occurred during the first postoperative days but this complication was diagnosed later in 3 instances by arteriography. Five out of 7 patients transplanted for malignant liver disease experienced recurrence which cause death in 4 cases. In 3 out of the 5 patients transplanted for postviral B cirrhosis, chronic active hepatitis occurred 6 months after transplantation and one of these patients had to be retransplanted at 13 months for recurrence of cirrhosis.(ABSTRACT TRUNCATED AT 250 WORDS)
Insights
Postoperative complications after liver transplantation were most common in the first 3 months, with viral infections like Cytomegalovirus being frequent. Graft failure and disease recurrence were significant concerns, impacting patient survival.
Area of Science:
- Hepatology
- Transplantation Surgery
- Infectious Diseases
Background:
- Orthotopic liver transplantation (OLT) is a complex procedure with significant postoperative risks.
- Understanding non-rejection-related complications is crucial for improving patient outcomes.
Purpose of the Study:
- To analyze the spectrum and incidence of postoperative complications in OLT patients, excluding graft rejection.
- To identify common complications, their timing, and their impact on patient mortality.
Main Methods:
- Retrospective analysis of 52 consecutive OLTs performed between March 1986 and November 1988.
- Detailed review of patient records to document all postoperative complications, causes of death, and graft outcomes.
Main Results:
- Infection was the most frequent complication, primarily viral (Cytomegalovirus in 62%).
- Technical issues included bleeding, hematoma, and biliary stenosis; 3 patients had hepatic infarction.
- Disease recurrence was observed in 5/7 patients transplanted for malignancy and 3/5 for post-viral B cirrhosis.
Conclusions:
- Postoperative complications, particularly infections, predominantly occur within the first three months post-OLT.
- Graft failure, disease recurrence, and specific infections like disseminated candidiasis significantly contribute to mortality.
- Careful monitoring for technical complications and disease recurrence is essential in OLT recipients.