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Liver Transplantation for Hepatic Trauma: A Study From the European Liver Transplant Registry
Marek Krawczyk1, Michał Grąt, Rene Adam
11 Department of General, Transplant and Liver Surgery, Medical University of Warsaw, Warsaw, Poland.2 Hepato-Biliary Center, AP-HP Paul Brousse Hospital, University Paris-Sud, Villejuif, France.3 Division of Hepatopancreatobiliary and Transplantation Surgery, Department of Surgery, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands.4 Department of General, Visceral and Transplantation Surgery, Hannover Medical School, Hannover, Germany.5 Department of General Surgery and Transplantation, Sant'Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy.6 Hepato-Pancreato-Biliary Surgery and Liver Transplantation Unit, Department of Surgery and Transplantation, University of Modena and Reggio Emilia, Modena, Italy.7 Hepatobiliary Surgery and Liver Transplantation, University of Pisa Medical School Hospital, Pisa, Italy.8 Department of General and Visceral Surgery, University Hospital of Muenster, Muenster, Germany.9 Department of Transplantation, Oslo University Hospital, Rikshospitalet, Oslo, Norway.10 Unit of Surgery and Liver Transplantation, Hospital Universitario Reina Sofia, Córdoba, Spain.11 Transplant Institute, Sahlgrenska University Hospital, Sahlgrenska Academy, Gothenburg, Sweden.12 Department of Abdominal, Visceral and Transplantation Surgery, Charité Universitätsmedizin, Campus Virchow, Berlin, Germany.13 Department of General and Transplant Surgery, University Hospital Essen, Essen, Germany.14 Department of General, Visceral and Vascular Surgery, Jena University Hospital, Jena, Germany.15 Unità Operativa Chirurgia Generale e Trapianti di Fegato, Fondazione IRCCS Ospedale Maggiore Policlinico, Mangiagalli e Regina Elena, Milan, Italy.16 Liver Transplant Center, General Surgery Unit, A.O. Città della Salute e della Scienza, Molinette Hospital, University of Turin, Turin, Italy.17 Liver Transplant Unit, Hospital Juan Canalejo, La Coruna, Spain.18 Abdominal Trasplant Unit, Universitary Clinical Hospital, Santiago de Compostela, Spain.19 Hepatic-Biliary-Pancreatic Surgery and Liver Transplant Unit, University Hospital Virgen del Rocío of Seville, Seville, Spain.20 Abdominal Transplant Surgery, University Hospitals Leuven, Leuven, Belgium.21 Department of Abdominal Surgery and Transplantation, Centre Hospitalier Universitaire de Liège, University of Liège, Liège, Belgium.22 Department of Visceral and Transplantation Surgery, University Hospitals, Geneva, Switzerland.23 Center of Cardiovascular Surgery and Transplantations, Brno, Czech Republic.24 Department of General and Visceral Surgery, Goethe University Hospital and Clinics, Frankfurt, Germany.25 Department of Visceral, Transplant, Vascular and Thoracic Surgery, University Hospital of Leipzig, Leipzig, Germany.26 Department of General, Visceral and Transplant Surgery, University Hospital Tübingen, Tübingen, Germany.27 Service de Chirurgie Digestive et Transplantation, University Lille Nord de France, Centre Hospitalier Universitaire Lille, Lille, France.28 The Liver Unit, Queen Elizabeth Hospital Birmingham Edgbaston, Birmingham, United Kingdom.29 Institute of General Surgery and Liver Transplantation, Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy.30 Department of Surgery, Pope John XXIII Hospital, Bergamo, Italy.31 Department of Experimental Medicine and Surgery, Section of Transplantation, Tor Vergata University of Rome, Rome, Italy.32 Division of Transplantation, Department of Surgery, Leiden University Medical Center, Leiden University, Leiden, The Netherlands.33 Department of Surgery and Organ Transplantation, Porto, Portugal.34 Department of HBP Surgery and Transplant, Hospital Universitari Vall d'Hebro'n, Autonomous University of Barcelona, Barcelona, Spain.35 Service of General and Digestive Surgery and Abdominal Organ Transplantation, "Doce de Octubre", University Hospital, Madrid, Spain.36 Liver Unit, Gregorio Marañón University Hospital, Madrid, Spain.37 Unidad de Trasplante Hepatico, Hospital Universitarro Puerta de Hierro, Madrid, Spain.38 Hepatobiliopancreatic Surgery and Transplantation Unit, La Fe University Hospital, Valencia, Spain.39 Inonu University, Liver Transplantation Institute, Malatya, Turkey.
Background:
Liver transplantation is the most extreme form of surgical management of patients with hepatic trauma, with very limited literature data supporting its use. The aim of this study was to assess the results of liver transplantation for hepatic trauma.
Methods:
This retrospective analysis based on European Liver Transplant Registry comprised data of 73 recipients of liver transplantation for hepatic trauma performed in 37 centers in the period between 1987 and 2013. Mortality and graft loss rates at 90 days were set as primary and secondary outcome measures, respectively.
Results:
Mortality and graft loss rates at 90 days were 42.5% and 46.6%, respectively. Regarding general variables, cross-clamping without extracorporeal veno-venous bypass was the only independent risk factor for both mortality (P = 0.031) and graft loss (P = 0.034). Regarding more detailed factors, grade of liver trauma exceeding IV increased the risk of mortality (P = 0.005) and graft loss (P = 0.018). Moreover, a tendency above the level of significance was observed for the negative impact of injury severity score (ISS) on mortality (P = 0.071). The optimal cut-off for ISS was 33, with sensitivity of 60.0%, specificity of 80.0%, positive predictive value of 75.0%, and negative predictive value of 66.7%.
Conclusions:
Liver transplantation seems to be justified in selected patients with otherwise fatal severe liver injuries, particularly in whom cross-clamping without extracorporeal bypass can be omitted. The ISS cutoff less than 33 may be useful in the selection process.