Can Delayed Abdominal Fascia Closure Modify the Short Term Outcome after Adult Liver Transplantation?

I. Vella,¹ M. Pellicciaro,¹ G. Ciancio,² T. Manzia,¹ R. Angelico,³ J. Gaynor,² G. Iaria,¹ G. Tisone,¹ R. Vianna.²

¹Transplant Unit, University of Rome "Tor Vergata", Rome, Italy
²Miami Transplant Institute, University of Miami Miller School of Medicine, Miami
³Ospedale Pediatrico Bambino Ges[ugrave], Rome, Italy.

Meeting: 2018 American Transplant Congress

Abstract number: A242

Keywords: Graft failure, Liver transplantation, Post-operative complications, Vascular disease

Session Information

Session Name: Poster Session A: Liver Retransplantation and Other Complications

Session Type: Poster Session

Date: Saturday, June 2, 2018

Session Time: 5:30pm-7:30pm

Presentation Time: 5:30pm-7:30pm

Location: Hall 4EF

Background

The abdominal fascia at the end of adult liver transplantation could often represents a dangerous procedure, complicated by graft size mismatch and post reperfusion hepatic or intestinal edema. According to these considerations, at the Miami Transplant Institute has been experienced a surgical approach consisting in a delayed abdominal fascia closure (DAC), in order to reduce all risks linked to an increased abdominal pressure.

Method

The aim of this retrospective study is to determine the influence of DAC on the 3 months outcome after adult LT. Were included 270 adult patients consecutively transplanted with a MELD score ≥20 points, excluding liver re-transplantation and combined organ transplant (period: January 2009-December 2016). Patients were divided in a Group A (n:134) subjected to DAC and a Group B (n:136) studied as a control group. All data about donors and recipients' conditions at the baseline, their vascular anatomy, and all data about the surgical procedure were analyzed and were not recorded significant differences. The follow-up was evaluated by blood tests and reporting any complications.

Results

Overall, patient survival was not significantly different between the 2 groups (P=.08). However, death-censored graft failure was significantly higher in Group B, with 9 patients developing graft failure versus none in Group A (P=.003). Causes of graft failure indicate that most (7/9) were due to hepatic artery thrombosis, which was the only one complication with a different significant incidence (11 in Group B versus 0 in Group A, P=.0008). The significantly higher graft survival in Group A (P=.007) was primarily due to the observed graft failure rate difference. Moreover, necessity of reoperation for complication was lower in Group A (P=.001) without differences about the hospital stay between the two groups (P=.56).

Conclusion

DAC seems to be associated with a reduced incidence of graft loss and hepatic artery thrombosis. This surgical management has increased the outcome in our patients. According to our results, a wider use of techniques that make it possible to reduce intra-abdominal pressure at the end of LT even in adult patients is suitable.

CITATION INFORMATION: Vella I., Pellicciaro M., Ciancio G., Manzia T., Angelico R., Gaynor J., Iaria G., Tisone G., Vianna R. Can Delayed Abdominal Fascia Closure Modify the Short Term Outcome after Adult Liver Transplantation? Am J Transplant. 2017;17 (suppl 3).

To cite this abstract in AMA style:

Vella I, Pellicciaro M, Ciancio G, Manzia T, Angelico R, Gaynor J, Iaria G, Tisone G, Vianna R. Can Delayed Abdominal Fascia Closure Modify the Short Term Outcome after Adult Liver Transplantation? [abstract]. https://atcmeetingabstracts.com/abstract/can-delayed-abdominal-fascia-closure-modify-the-short-term-outcome-after-adult-liver-transplantation/. Accessed November 23, 2024.

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