What makes a Difficult Liver Transplantation?

Introduction Although liver transplantation (LT) is among the most complicated abdominal surgical procedures, surgical difficulty of LT was to date not objectively defined. Azoulay proposed recently a point-based system, depending on cold ischemia time (CIT), blood units transfused intraoperatively, and duration of operation, which showed promising results in short-term outcomes in two centers in France and Spain. Our aim was to validate this model in our high-output LT center in the Eurotransplant region and to combine donor and recipient data to highlight high-risk combinations to aid transplant physicians when considering individual candidates.

Methods We retrospectively analyzed 781 patients who were transplanted between January 2010 and January 2023 at our center. Points were assigned as by Azoulay with a modification, as instead of CIT, duration of hepatectomy was calculated. All values at or above the median value of the whole population defined a difficult LT. The correlation of difficult LT with 90-day mortality was assessed. Predictors of difficult LT will be identified via multivariable analysis using recipient, donor, and surgical data.

Results The incidence of difficult LT was 19.3% in our cohort. Difficult LT was associated with a lower 90-day survival (71.5% vs. 88.5% in case of non-difficult LT, p<0.0001). Predictors of a difficult LT will be assessed by multivariable analysis.

Discussion Difficult LT as defined here occurs frequently and results in poorer postoperative outcomes. Early recognition of these cases, adjusting risk factors and optimizing donor-recipient matching may improve future results.

Publication History

Article published online:
23 January 2024