Liver Transplantation for Hepatic Trauma: A Study From the European

Abstract

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 ofmortality (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) onmortality (P = 0.071). The optimal cutoff 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.

C1 [Krawczyk, Marek; Grat, Michal] Med Univ Warsaw, Dept Gen Transplant & Liver Surg, 1A Banacha St, PL-02097 Warsaw, Poland.

[Adam, Rene] Univ Paris Sud, Paul Brousse Hosp, AP HP, Hepato Biliary Ctr, Villejuif, France.

[Polak, Wojciech G.] Univ Med Ctr Rotterdam, Erasmus MC, Dept Surg, Div Hepatopancreatobiliary & Transplantat Surg, Rotterdam, Netherlands.

[Klempnauer, Jurgen] Hannover Med Sch, Dept Gen Visceral & Transplantat Surg, Hannover, Germany.

[Pinna, Antonio] Univ Bologna, St Orsola Malpighi Hosp, Dept Gen Surg & Transplantat, Bologna, Italy.

[Di Benedetto, Fabrizio] Univ Modena & Reggio Emilia, Dept Surg & Transplantat, Hepatopancreato Biliary Surg & Liver Transplanta, Modena, Italy.

[Filipponi, Franco] Univ Pisa, Hepatobiliary Surg & Liver Transplantat, Med Sch Hosp, Pisa, Italy.

[Senninger, Norbert] Univ Hosp Muenster, Dept Gen & Visceral Surg, Munster, Germany.

[Foss, Aksel] Oslo Univ Hosp, Rikshosp, Dept Transplantat, Oslo, Norway.

[Rufian-Pena, Sebastian] Hosp Univ Reina Sofia, Unit Surg & Liver Transplantat, Cordoba, Spain.

[Bennet, William] Sahlgrens Univ Hosp, Sahlgrenska Acad, Transplant Inst, Gothenburg, Sweden.

[Pratschke, Johann] Charite, Dept Abdominal Visceral & Transplantat Surg, Campus Virchow, Berlin, Germany.

[Paul, Andreas] Univ Hosp Essen, Dept Gen & Transplant Surg, Essen, Germany.

[Settmacher, Utz] Jena Univ Hosp, Dept Gen Visceral & Vasc Surg, Jena, Germany.

[Rossi, Giorgio] Fdn IRCCS Osped Maggiore Policlin Mangiagali & Re, Unita Operat Chirurg Gen & Trapianti Fegato, Milan, Italy.

[Salizzoni, Mauro] Univ Turin, Molinette Hosp, AO Citta Salute & Sci, Gen Surg Unit,Liver Transolant Ctr, Turin, Italy.

[Fernandez-Selles, Carlos] Hosp Juan Canalejo, Liver Transplant Unit, La Coruna, Spain.

[Martinez de Rituerto, Santiago T.] Univ Clin Hosp, Abdominal Trasplant Unit, Santiago De Compostela, Spain.

[Gomez-Bravo, Miguel A.] Univ Hosp Virgen Roc Seville, Hepat Biliary Pancreat Surg & Liver Transplant Un, Seville, Spain.

[Pirenne, Jacques] Univ Hosp Leuven, Abdominal Transplant Surg, Leuven, Belgium.

[Detry, Olivier] Univ Liege, Ctr Hosp Univ Liege, Dept Abdominal Surg & Transplantat, Liege, Belgium.

[Majno, Pietro E.] Univ Hosp, Dept Visceral & Transplantat Surg, Geneva, Switzerland.

[Bechstein, Wolf O.] Ctr Cardiovasc Surg & Transplantat, Brno, Czech Republic.

[Bartels, Michael] Goethe Univ, Hosp & Clin, Dept Gen & Visceral Surg, Frankfurt, Germany.

[Nadalin, Silvio] Univ Hosp Leipzig, Dept Visceral Transplant Vasc & Thorac Surg, Leipzig, Germany.

[Pruvot, Francois R.] Univ Hosp Tubingen, Dept Gen Visceral & Transplant Surg, Tubingen, Germany.

[Mirza, Darius F.] Univ Lille Nord France, CHU Lille, Serv Chirurg Digest & Transplantat, Lille, France.

[Lupo, Luigi] Queen Elizabeth Hosp Birmingham Edgbaston, Liver Unit, Birmingham, W Midlands, England.

[Colledan, Michele] Univ Bari, Dept Emergency & Organ Transplantat, Inst Gen Surg & Liver Transplantat, Bari, Italy.

[Tisone, Giuseppe] Pope John XXIII Hosp, Dept Surg, Bergamo, Italy.

[Ringers, Jan] Univ Roma Tor Vergata, Sect Transplantat, Dept Expt Med & Surg, Rome, Italy.

[Daniel, Jorge] Leiden Univ, Med Ctr, Div Transplantat, Dept Surg, Leiden, Netherlands.

[Charco Torra, Ramon] Dept Surg & Organ Transplantat, Oporto, Portugal.

[Moreno Gonzalez, Enrique] Autonomous Univ Barcelona, Hosp Univ Vall Hebron, Dept HBP Surg & Transplant, Barcelona, Spain.

[Banares Canizares, Rafael] Univ Hosp, Doce de Octubre, Serv Gen & Digest Surg & Abdominal Organ Transpla, Madrid, Spain.

[Cuervas-Mons Martinez, Valentin] Gregorio Maranon Univ Hosp, Liver Unit, Madrid, Spain.

[Juan Rodriguez, Fernando San] Hosp Univ Puerta Hierro, Unidad Trasplante Hepat, Madrid, Spain.

[Yilmaz, Sezai] La Fe Univ Hosp, Hepatobiliopancreat Surg & Transplantat Unit, Valencia, Spain.

[Yilmaz, Sezai] Inonu Univ, Liver Transplantat Inst, Malatya, Turkey.