Open abdomen in liver transplantation

Area of Science:

• Hepatobiliary Surgery
• Transplantation Medicine
• Surgical Critical Care

Background:

• Vacuum-assisted closure (VAC) is employed in trauma for damage control and in liver transplantation to manage intra-operative hemorrhage.
• Comparing peri-operative outcomes between VAC and primary abdominal closure (PAC) in liver transplantation is crucial for optimizing patient management.

Purpose of the Study:

• To evaluate and compare peri-operative blood loss and blood product utilization between VAC and PAC in liver transplant recipients.
• To assess the safety and efficacy of VAC in managing intra-operative bleeding during liver transplantation.

Main Methods:

• A retrospective review was conducted on adult patients who underwent deceased donor liver transplantation between 2007 and 2011 at a single tertiary care institution.
• Data collected included intra-operative blood loss, blood product transfusion requirements (red blood cells, fresh frozen plasma, platelets), and cell saver utilization.

Main Results:

• A total of 201 liver transplantations were analyzed: 167 with PAC and 34 with VAC.
• Patients undergoing VAC experienced significantly higher intra-operative blood loss (10.7L vs. 4.4L), cell saver return (3998ml vs. 1399ml), and requirements for fresh frozen plasma (15.9U vs. 7.6U) and platelets (18.3U vs. 8.5U) compared to PAC.
• VAC patients also showed increased requirements for red blood cells, fresh frozen plasma, platelets, and total fluid volume during initial ICU admission.

Conclusions:

• The application of VAC in liver transplantation, particularly secondary to massive intra-operative bleeding, was utilized safely.
• However, VAC was associated with significantly elevated peri-operative blood loss and blood product utilization compared to PAC.
• Further investigation is warranted to determine the long-term morbidity and mortality associated with VAC use in liver transplantation.