Surgical injuries of postmortem donor livers: Incidence and impact on outcome after adult liver transplantation

Authors

  • Danielle M. Nijkamp,

    Corresponding author
    1. Section of Transplantation and Organ Donation, University Medical Center Groningen, Groningen, The Netherlands
    • Department of Surgery, University Medical Center Groningen, P.O. Box 30001, 9700 RB Groningen, The Netherlands
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    • Telephone: 0031 50 361 3264; FAX: 0031 50 361 9050

  • Maarten J.H. Slooff,

    1. Section of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, University Medical Center Groningen, Groningen, The Netherlands
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  • Christian S. van der Hilst,

    1. Department of Medical Technology Assessment, University Medical Center Groningen, Groningen, The Netherlands
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  • Alexander J.C. IJtsma,

    1. Section of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, University Medical Center Groningen, Groningen, The Netherlands
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  • Koert P. de Jong,

    1. Section of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, University Medical Center Groningen, Groningen, The Netherlands
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  • Paul M.J.G. Peeters,

    1. Section of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, University Medical Center Groningen, Groningen, The Netherlands
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  • Robert J. Porte

    1. Section of Transplantation and Organ Donation, University Medical Center Groningen, Groningen, The Netherlands
    2. Section of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, University Medical Center Groningen, Groningen, The Netherlands
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Abstract

The exact frequency and clinical consequences of surgical hepatic injuries during organ procurement are unknown. We analyzed the incidence, risk factors, and clinical outcome of surgical injuries in 241 adult liver grafts. Hepatic injuries were categorized as parenchymal, vascular, or biliary. Outcome variables were bleeding complications, hepatic artery thrombosis (HAT), and graft survival. In 82 livers (34%), 96 injuries were detected. Most injuries were minor, but clinically relevant injuries were detected in 6.6% (16/241) of the livers. Fifty (21%) liver grafts had some degree of parenchymal or capsular injury, 40 (17%) had vascular injury, and 6 (2%) had an injury to the bile duct. Procurement region was the only risk factor significantly associated with surgical injury. The rate of hepatic artery injury was significantly higher in livers with aberrant arterial anatomy. Bleeding complications were found in 18% of patients who received livers with a parenchymal or capsular injury in contrast to 9% without parenchymal injury (P = 0.065). HAT was found in 23% of the patients who received a liver with arterial injury compared to 4% without arterial injury (P = 0.001). Overall graft survival rates were not significantly different for grafts with or without anatomical injury. In conclusion, surgical injuries of donor livers are an underestimated problem in liver transplantation and can be observed in about one-third of all cases. Clinically relevant injuries are detected in 6.6% of all liver grafts. Arterial injuries are associated with an increased risk of HAT. Liver Transpl 12:1365-1370, 2006. © 2006 AASLD.

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