Indications and Outcomes of Re-Exploratory Laparotomy in Adult Living Donor Liver Transplantation—Single-Center Experience of 1352 Consecutive Liver Transplantations from Indian Subcontinent

Abstract

Liver transplantation (LT) is the gold standard for end-stage liver disease (Prince Postgrad Med J 78:135–141, 2002). LT is a technically demanding operation. It needs experienced surgical team along with good anesthesia and critical care support (David et al. Gastroenterol Clin North Am 17:1–18, 1988). Survival after LT is approximately 90% at 1 year. Unlike other organs, 1 and 10-year survival for liver transplantation are the same (Jain and Reyes Ann Surg 232(4):490–500, 2000). Complications after LT are classified into technical, infective, and immunological (Moon and Lee Gut Liver 3(3):145–165, 2009). Re-exploratory laparotomy (REL) is one of the surgical complications of LT. Our study was aimed at analyzing the indications and impact of REL on the patient outcomes after living donor liver transplantation in our center. Retrospective analysis of all LTs done at our center by the same surgical team from January 1 2011 to June 30 2016 was included in the study. Pediatric transplants, combined liver kidney transplants, cadaveric transplants, planned REL, and re-transplantations were excluded from the study. Re-explored patients (REL) were classified as study group, and non-re-explored (NREL) patients were used as controls for statistical comparison. Twenty-five parameters (preoperative, intraoperative, and postoperative) between the two groups were studied. SPSS 22 statistical software was used for statistical analysis. The total number of LT during the study period was 1352. After exclusion, 1241 patients were in the study group. REL group had 111 patients. Out of 111 patients, 97 had one REL, 13 patients had two RELs, and 1 had three RELs. Hence, there were 126 RELs in 111 patients. NREL group had 1140 patients. REL rate in our series was 10.02%. On univariate analysis of 25 parameters analyzed between the two groups, age, graft weight, multiple bile ducts, and mortality were found to be statistically significant (P < 0.05). Preoperative total leucocyte count, model for end-stage liver disease, and warm ischemia time were statistically significant (P < 0.1). On subgroup analysis of REL, bleeding was the commonest indication followed by intraabdominal sepsis. Delayed non-function and small for size had high mortality rates. Multiple RELs were associated with higher mortality compared to single REL (P < 0.05). REL is associated with poor prognosis after adult living donor liver transplantation.