Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Jan 1;277(1):144-150.
doi: 10.1097/SLA.0000000000005017. Epub 2021 Jun 18.

Defining Surgical Difficulty of Liver Transplantation

Daniel Azoulay  1 , Chady Salloum  1 , Laura Llado  2 , Emilio Ramos  2 , Josefina Lopez-Dominguez  2 , Alba Cachero  2 , Joan Fabregat  2 , Cyrille Feray  2 , Chetana Lim  3
Affiliations

Defining Surgical Difficulty of Liver Transplantation

Daniel Azoulay et al. Ann Surg. .

Abstract

Objective: To define technically Diff-LT.

Summary of background data: Currently, there is no acknowledged definition of Diff-LT.

Methods: This retrospective study included all first consecutive liver-only transplantations performed in 2 centers from 2011 to 2015. Diff-LT was defined as the combination of the number of blood units transfused, cold ischemia time, and duration of operation, all at or above the median value of the entire population. The correlation of Diff-LT with short- (including the comprehensive complication index) and long-term outcomes was assessed. Outcomes were also compared to the 90-day benchmark cutoffs of LT. Predictors of Diff-LT were identified by multivariable analysis, first using only recipient data and then using all recipient, donor, graft, and surgical data.

Results: The study population included 467 patients. The incidence of Diff- LT was 18.8%. Diff-LT was associated with short-term outcomes, including the comprehensive complication index and mortality, but not with patient or graft long-term survival. Previous abdominal surgery, intensive care unitbound at the time of LT, split graft use, nonstandard arterial reconstruction, and porto-systemic shunt ligation were independent predictors of Diff-LT. The proportion of variables below the corresponding LT 90-day benchmark cutoffs was 8/13 (61.5%) for non-Diff-LT, and 4/13 (30.8%) for Diff-LT.

Conclusions: Diff-LT, as defined, occurred frequently. Adjusting modifiable variables might decrease the risk of Diff-LT and improve the postoperative course. This definition of Diff-LT might be useful for patient information, comparison between centers and surgeons, and as a metric in future trials.

PubMed Disclaimer

Conflict of interest statement

The authors report no funding and conflicts of interest.

References

    1. Law KE, Lowndes BR, Kelley SR, et al. Surgeon workload in colorectal surgery: perceived drivers of procedural difficulty. J Surg Res. 2019;245:57–63.
    1. Lowndes BR, Forsyth KL, Blocker RC, et al. NASA-TLX assessment of surgeon workload variation across specialties. Ann Surg. 2018;271:686–692.
    1. Lonze BE, Parsikia A, Feyssa EL, et al. Operative start times and complications after liver transplantation. Am J Transplant. 2010;10:1842–1849.
    1. Neuberger J. Surgery: Day or night–does the time of liver transplantation matter? Nat Rev Gastroenterol Hepatol. 2010;7:596–597.
    1. Yersiz H, Lee C, Kaldas FM, et al. Assessment of hepatic steatosis by transplant surgeon and expert pathologist: a prospective, double-blind evaluation of 201 donor livers. Liver Transpl. 2013;19:437–449.