*Purpose: Few studies have evaluated the impact of previous abdominal surgery (PAS) on deceased donor liver transplantation-(DDLT). Furthermore, there is no evidence of impact of pre-LT surgical-risk-categorization on recipients with PAS. We evaluated the outcomes of liver-transplantation in patients with PAS and surgical-risk-categorization.

*Methods: Our Institution has been assigning the potential recipient with surgical-complexity-category since 2014 to preempt surgical-risk (Table 1) and optimize resource-utilization for complex-cases. Outcome data from all N=485 DDLT-recipients (N=235 with PAS, N=250 with no PAS) operated between Jan-15 and June-17 were compared. The primary-endpoint of the study was patient-survival and graft-survival at 30 d, 180 d and 1 year. As secondary-outcomes, hospital-stay, waiting-time, early-allo-graft-dysfunction, biliary-complications, hepatic-artery-stenosis/thrombosis, portal-vein-thrombosis, re-exploration rates were compared. Propensity-score (PS) estimation with nearest-neighbor-matching, controlling for donor/recipient age; BMI and DRI, matched N=168 PAS & N=168 non-PAS-recipients. Multivariate-analysis for Patient/Graft-Survival was performed using the Cox-proportional-hazards-model.

*Results: There were no significant differences in Graft/Patient survival in PAS/no PAS matched cohorts at 30 d, 180 d and 1 year (Fig-1). Recipients with PAS had higher-median-waiting-time, Cold-ischemia-time and Total-procedure-time. (Table-2). 92% recipients in PAS-cohort had DBD-DDLT v/s 71% in no-PAS-cohort (p=0.003). There were no statistical-differences in Early-Allograft-Dysfunction-rate OR-1.31(0.78-2.19); Biliary-complication-rate OR-1.26(0.79-2.01); Hepatic-Artery-Stenosis-rate OR-1.37(0.73-2.58); Hepatic-Artery-thrombosis-rate OR-1.33(0.35-5.01); Portal-vein-thrombosis-rate OR-1.07(0.51-2.23) and Re-Exploration-rate OR-1.25(0.64-2.45). DDLT-PAS-cohort had higher intra-op-RBC >5-units OR-1.04(1.02- 1.07) and AKI OR-1.51(1.02-2.24). On sub group analysis of no PAS v/s Lower (LAS) and Upper (UAS) abdominal surgery.,UAS had higher intra-operative RBC transfusion rate and Operative Time(p<0.001) compared to no PAS cohort. Results were similar between no-PAS and LAS group (p=NS). On sub-sub group analysis of UAS cohort ; Re Transplant, hepatobiliary, bariatric surgeries cohort had higher RBC transfusion rate, longer OT and hospital stay compared to lap cholecystectomy. (p<0.001)

*Conclusions: PAS impacts the LT procedure yet granular analysis suggests that complicated UAS has higher risk of inferior outcomes than straightforward lap cholecystectomies and LAS. By using pre-listing surgical categorization and resource management, we were able to achieve equitable results with complex transplants..

« Back to 2019 American Transplant Congress