Female Gender of the Recipient Is Independently Associated With Prolonged Ventilation Time and Hospital Stay After Liver Transplantation.

BACKGROUND: Although female patients are associated with several complications after liver transplantation (OLT), its role in short-term postoperative outcomes is not known. The aims of this study were to investigate the relationship between female gender and ventilation time and hospital stay after OLT. METHODS: After receiving institutional review board approval, we studied adult patients who underwent OLT at our center between 2004 and 2013. Female and male recipients were compared by using Student t and χ(2) tests. Risk factors were confirmed in multivariate logistic models. RESULTS: Of 1476 patients, 490 were female. Compared with male counterparts, female recipients had more severe disease and comorbidities. Intraoperatively, the 2 groups were similar except for blood transfusion. Postoperatively, female recipients required significantly longer ventilation time (median, 3 days [interquartile range (IQR), 2-5], vs median, 2 [IQR, 1-5]; P = .009) and duration of hospital stay (median, 23 [IQR, 15-46] vs median, 18 [IQR, 12-34]; P < .001) compared with male recipients. Female gender was an independent risk factor for prolonged posttransplant ventilation time (≥3 days; odds ratio [OR], 1.65; P < .001) and hospital stay (≥19 days; OR, 1.48; P = .003). CONCLUSIONS: Female gender of the recipient is associated with significantly longer ventilation time and hospital stay after OLT and the management should be tailored to the unique characteristics and susceptibility to postoperative complications in female patients.

Intraoperative Management and Postoperative Outcome in Intestine-Inclusive Liver Transplantation Versus Liver Transplantation.

BACKGROUND: Although intestine-inclusive liver transplantation (IILT) is performed regularly, its perioperative management has not been studied extensively. METHODS: Patients who underwent IILT and isolated liver transplantation (LT) at our center from January 2006 to December 2012 were identified. Among >1,000 LT patients, 90 were selected after matching by age, sex, surgery date, and status of preoperative ventilation for comparison with 45 IILT patients. RESULTS: There were no significant differences regarding preoperative variables between the 2 groups except for international normalized ratio. However, IILT patients had significantly higher intraoperative requirement of blood transfusion, incidences of post-reperfusion syndrome, and hyperkalemia compared with LT patients. Postoperatively, IILT patients had significantly longer hospital stay and higher 1-year mortality. Multivariate analysis indicated that IILT was a primary risk factor associated with the studied complications and adverse outcomes. CONCLUSIONS: Our findings suggest that, compared with LT patients, IILT patients were more prone to develop intraoperative complications and adverse outcomes and should be closely monitored and aggressively managed.

Postoperative atrial fibrillation in liver transplantation.

Postoperative atrial fibrillation (POAF) is common after major surgeries and is associated with increased morbidity and mortality. POAF after liver transplantation (LT) has not been reported. This study was undertaken to investigate the incidence, impact, and risk factors of POAF in LT patients. After IRB approval, LT between January 2006 and August 2013 at our center were retrospectively reviewed. POAF that occurred within 30 days after LT was included. Patients with and without POAF were compared and independent risk factors were identified by logistic regression. Of 1387 adults LT patients, 102 (7.4%) developed POAF during the study period. POAF was associated with significantly increased mortality, graft failure, acute kidney injury and prolonged hospital stay. Independent risk factors included age, body weight, MELD score, presence of previous history of AF, the vasopressors use prior to LT and pulmonary artery diastolic pressure at the end of LT surgery (odds ratios 2.0-7.2, all p < 0.05). A risk index of POAF was developed and patients with the high-risk index had more than 60% chance of developing POAF. These findings may be used to stratify patients and to guide prophylaxis for POAF in the posttransplant period.

Extended criteria donor and severe intraoperative glucose variability: association with reoperation for hemorrhage in liver transplantation.

Reoperations for hemorrhage following liver transplantation (OLT) are commonly associated with increased morbidity and mortality. We sought to determine the incidence and risk factors for reoperation for hemorrhage among adult liver transplantations. We retrospectively analyzed 668 patients transplanted between January 2004 and November 2007. Within 30 days following transplantation one hundred eleven patients (16.6%) underwent 156 reoperations for hemorrhage, averaging 1.4 reoperations per patient. More than half of the reoperations occurred during the first 2 postoperative days. One-third of patients required 2 or more reoperations. Multivariate logistic regression analysis showed 4 independent risk factors: grafts from donors with multiple extended criteria, severe intraoperative glucose variability, intraoperative use of vasopressors, and red blood cell transfusion requirement. In conclusion, we identified several independent risk factors for reoperation due to hemorrhage following OLT. Avoidance of severe intraoperative glucose variability and careful evaluation of the benefits and risks of utilizing extended criteria donors must be considered before transplantation.

Ascites, but not hyponatremia, is associated with high intraoperative transfusion and vasopressor requirements during liver transplantation.

BACKGROUND: We previously demonstrated that patients with high MELD scores required significantly higher volumes of blood transfusion and vasopressor usage during orthotopic liver transplantation (OLT) compared with patients with low MELD scores. Now we investigated whether hyponatremia or ascites were associated with increased transfusion and vasopressor requirements during OLT. METHODS: Medical records of 192 OLT patients between January 1, 2004, and May 5, 2005, were retrospectively reviewed. Intraoperative transfusion of red blood cells (RBC) or fresh frozen plasma (FFP) and administration of vasopressors were compared. RESULTS: As expected, patients with high (>30) MELD scores were associated with higher requirements for intraoperative transfusion and vasopressors than those with low ( or 30) MELD plus ascites scores (MELD+A, 4.5 points added to MELD if ascites was present) had higher requirements for transfusion and vasopressors compared with patients with low (