Transcapsular arterial neovascularization of liver transplants increases the risk of intraoperative bleeding during retransplantation.

TY - JOUR

T1 - Transcapsular arterial neovascularization of liver transplants increases the risk of intraoperative bleeding during retransplantation.

AU - Herrmann, Jochen

AU - Herden, Uta

AU - Ganschow, Rainer

AU - Petersen, Kay U

AU - Schmid, Felix

AU - Derlin, Thorsten

AU - Koops, Andreas

AU - Peine, Sven

AU - Sterneck, Martina

AU - Fischer, Lutz

AU - Helmke, Knut

N1 - © 2013 The Authors Transplant International © 2013 European Society for Organ Transplantation. Published by Blackwell Publishing Ltd.

PY - 2013

Y1 - 2013

N2 - Arterial neovascularization of liver grafts can be a source of significant blood loss during retransplantation. This study evaluated the effect of transcapsular arterial neovascularization on intraoperative blood loss during retransplantation and long-term follow-up. Eleven consecutive patients with transcapsular arterial neovascularization (seven male, four female; nine children, two adults; mean age 12.3 ± 16.3 years) and the same number of matched control patients were analysed. Blood loss was calculated based on transfusion requirements. The volume of transfused units of red blood cells per kilogram bodyweight until hepatectomy and during the entire procedure was significantly higher in patients with neovascularization than in control patients (0.32 ± 0.21 vs. 0.14 ± 0.11, and 0.94 ± 0.83 vs. 0.36 ± 0.38 respectively; P-values 0.027). Neovascularization was associated with extensive intra-abdominal adhesions and a longer operating time until hepatectomy (175.6 ± 52.1 min vs. 124.3 ± 34.9 min, P-value 0.015). Postoperative revisions were performed more frequently in patients with neovessels. Graft survival did not differ between groups. Assessment for transcapsular arterial neovascularization should be included in preoperative Doppler ultrasound protocols to identify patients at risk of a complicated intra- and postoperative course in case of retransplantation.

AB - Arterial neovascularization of liver grafts can be a source of significant blood loss during retransplantation. This study evaluated the effect of transcapsular arterial neovascularization on intraoperative blood loss during retransplantation and long-term follow-up. Eleven consecutive patients with transcapsular arterial neovascularization (seven male, four female; nine children, two adults; mean age 12.3 ± 16.3 years) and the same number of matched control patients were analysed. Blood loss was calculated based on transfusion requirements. The volume of transfused units of red blood cells per kilogram bodyweight until hepatectomy and during the entire procedure was significantly higher in patients with neovascularization than in control patients (0.32 ± 0.21 vs. 0.14 ± 0.11, and 0.94 ± 0.83 vs. 0.36 ± 0.38 respectively; P-values 0.027). Neovascularization was associated with extensive intra-abdominal adhesions and a longer operating time until hepatectomy (175.6 ± 52.1 min vs. 124.3 ± 34.9 min, P-value 0.015). Postoperative revisions were performed more frequently in patients with neovessels. Graft survival did not differ between groups. Assessment for transcapsular arterial neovascularization should be included in preoperative Doppler ultrasound protocols to identify patients at risk of a complicated intra- and postoperative course in case of retransplantation.

KW - Adolescent

KW - Adult

KW - Blood Loss, Surgical

KW - Case-Control Studies

KW - Child

KW - Child, Preschool

KW - Female

KW - Humans

KW - Infant

KW - Liver Transplantation

KW - Male

KW - Middle Aged

KW - Neovascularization, Pathologic

KW - Reoperation

KW - Retrospective Studies

KW - Risk

U2 - 10.1111/tri.12062

DO - 10.1111/tri.12062

M3 - SCORING: Journal article

C2 - 23350918

VL - 26

SP - 419

EP - 427

JO - TRANSPL INT

JF - TRANSPL INT

SN - 0934-0874

IS - 4

M1 - 4

ER -