Impact of preoperative uncontrollable hepatic hydrothorax and massive ascites in adult liver transplantation.

Abstract

PURPOSE:

Uncontrollable hepatic hydrothorax and massive ascites (H&MA) requiring preoperative drainage are sometimes encountered in liver transplantation (LT). We retrospectively analyzed the characteristics of such patients and the impact of H&MA on the postoperative course.

METHODS:

We evaluated 237 adult patients who underwent LT in our institute between April 2006 and October 2010.

RESULTS:

Recipients with uncontrollable H&MA (group HA: n = 36) had more intraoperative bleeding, higher Child-Pugh scores, lower serum albumin concentrations and higher blood urea nitrogen concentrations than those without uncontrollable H&MA (group C: n = 201). They were also more likely to have preoperative hepatorenal syndrome and infections. The incidence of postoperative bacteremia was higher (55.6 vs. 46.7%, P = 0.008) and the 1- and 3-year survival rates were lower (1 year: 58.9 vs. 82.9%; 3 years: 58.9 vs. 77.7%; P = 0.003) in group HA than in group C. The multivariate proportional regression analyses revealed that uncontrollable H&MA and the Child-Pugh score were independent risk factors for the postoperative prognosis.

CONCLUSIONS:

Postoperative infection control may be an important means of improving the outcome for patients with uncontrollable H&MA undergoing LT, and clinicians should strive to perform surgery before H&MA becomes uncontrollable.

• Authors: Kosuke Endo, Taku Iida, Shintaro Yagi, Atsushi Yoshizawa, Yasuhiro Fujimoto, Kohei Ogawa, Yasuhiro Ogura, Akira Mori, Toshimi Kaido, Shinji Uemoto
• Journal: Surgery today (Surg Today) Vol. 44 Issue 12 Pg. 2293-9 (Dec 2014) ISSN: 1436-2813 [Electronic] Japan
• PMID: 24509883 (Publication Type: Journal Article)

Topics

• Adult
• Ascites (therapy)
• Bacteremia (epidemiology)
• Drainage
• Female
• Humans
• Hydrothorax (therapy)
• Liver Transplantation (mortality)
• Male
• Middle Aged
• Postoperative Complications (epidemiology)
• Preoperative Care
• Preoperative Period
• Prognosis
• Regression Analysis
• Retrospective Studies
• Risk Factors
• Severity of Illness Index
• Survival Rate