[en] BACKGROUND: Liver transplantation is the most extreme form of surgical management of patients with hepatic trauma, with very limited literature data supporting its use. The aim of this study was to assess the results of liver transplantation for hepatic trauma. METHODS: This retrospective analysis based on European Liver Transplant Registry comprised data of 73 recipients of liver transplantation for hepatic trauma performed in 37 centers in the period between 1987 and 2013. Mortality and graft loss rates at 90 days were set as primary and secondary outcome measures, respectively. RESULTS: Mortality and graft loss rates at 90 days were 42.5% and 46.6%, respectively. Regarding general variables, cross-clamping without extracorporeal veno-venous bypass was the only independent risk factor for both mortality (P = 0.031) and graft loss (P = 0.034). Regarding more detailed factors, grade of liver trauma exceeding IV increased the risk of mortality (P = 0.005) and graft loss (P = 0.018). Moreover, a tendency above the level of significance was observed for the negative impact of injury severity score (ISS) on mortality (P = 0.071). The optimal cut-off for ISS was 33, with sensitivity of 60.0%, specificity of 80.0%, positive predictive value of 75.0%, and negative predictive value of 66.7%. CONCLUSIONS: Liver transplantation seems to be justified in selected patients with otherwise fatal severe liver injuries, particularly in whom cross-clamping without extracorporeal bypass can be omitted. The ISS cutoff less than 33 may be useful in the selection process.
Disciplines :
Surgery
Author, co-author :
Krawczyk, Marek
Grat, Michal
Adam, Rene
Polak, Wojciech G.
Klempnauer, Jurgen
Pinna, Antonio
Di Benedetto, Fabrizio
Filipponi, Franco
Senninger, Norbert
Foss, Aksel
Rufian-Pena, Sebastian
Bennet, William
Pratschke, Johann
Paul, Andreas
Settmacher, Utz
Rossi, Giorgio
Salizzoni, Mauro
Fernandez-Selles, Carlos
Martinez de Rituerto, Santiago T.
Gomez-Bravo, Miguel A.
Pirenne, Jacques
DETRY, Olivier ; Centre Hospitalier Universitaire de Liège - CHU > Chirurgie abdo, sénologique, endocrine et de transplantation
Reddy NB, Hanumantha, Madithati P, et al. An epidemiological study on pattern of thoraco-abdominal injuries sustained in fatal road traffic accidents of Bangalore: autopsy-based study. J Emerg Trauma Shock. 2014;7:116-120.
Subedi N, Yadav BN, Jha S, et al. A profile of abdominal and pelvic injuries in medico-legal autopsy. J Forensic Leg Med. 2013;20:792-796.
Tinkoff G, Esposito TJ, Reed J, et al. American Association for the Surgery of Trauma Organ Injury Scale I: spleen, liver, and kidney, validation based on the National Trauma Data Bank. J Am Coll Surg. 2008;207:646-655.
Badger SA, Barclay R, Campbell P, et al. Management of liver trauma. World J Surg. 2009;33:2522-2537.
David Richardson J, Franklin GA, Lukan JK, et al. Evolution in the management of hepatic trauma: a 25-year perspective. Ann Surg. 2000;232: 324-330.
Petrowsky H, Raeder S, Zuercher L, et al. A quarter century experience in liver trauma: a plea for early computed tomography and conservative management for all hemodynamically stable patients. World J Surg. 2012;36: 247-254.
Shrestha B, Holcomb JB, Camp EA, et al. Damage-control resuscitation increases successful nonoperative management rates and survival after severe blunt liver injury. J Trauma Acute Care Surg. 2015;78:336-341.
Hommes M, Navsaria PH, Schipper IB, et al. Management of blunt liver trauma in 134 severely injured patients. Injury. 2015;46:837-842.
Balakrishnan A, Abbadi R, Oakland K, et al. Outcomes following liver trauma in equestrian accidents. J Trauma Manag Outcomes. 2014;8:13.
MacGoey P Navarro A, Beckingham IJ, et al. Selective non-operative management of penetrating liver injuries at a UK tertiary referral centre. Ann R Coll Surg Engl. 2014;96:423-426.
Pachter HL, Knudson MM, Esrig B, et al. Status of nonoperative manage-ment of blunt hepatic injuries in 1995: a multicenter experience with 404 patients. J Trauma. 1996;40:31-38.
Croce MA, Fabian TC, Menke PG, et al. Nonoperative management of blunt hepatic trauma is the treatment of choice for hemodynamically stable patients. Results of a prospective trial. Ann Surg. 1995;221:744-753.
Demetriades D, Hadjizacharia P Constantinou C, et al. Selective nonoperative management of penetrating abdominal solid organ injuries. Ann Surg. 2006;244:620-628.
Polanco PM, Brown JB, Puyana JC, et al. The swinging pendulum: a na-tional perspective of nonoperative management in severe blunt liver injury. J Trauma Acute Care Surg. 2013;75:590-595.
van der Wilden GM, Velmahos GC, Emhoff T, et al. Successful nonopera-tive management of the most severe blunt liver injuries: a multicenter study of the research consortium of new England centers for trauma. Arch Surg. 2012;147:423-428.
Kaltenborn A, Reichert B, Bourg CM, et al. Long-term outcome analysis of liver transplantation for severe hepatic trauma. J Trauma Acute Care Surg. 2013;75:864-869.
Plackett TP, Barmparas G, Inaba K, et al. Transplantation for severe he-patic trauma. J Trauma. 2011;71:1880-1884.
Patrono D, Brunati A, Romagnoli R, et al. Liver transplantation after severe hepatic trauma: a sustainable practice. A single-center experience and review of the literature. Clin Transplant. 2013;27:E528-E537.
Karam V, Gunson B, Roggen F, et al. Quality control of the European Liver Transplant Registry: results of audit visits to the contributing centers. Transplantation. 2003;75:2167-2173.
Delis SG, Bakoyiannis A, Selvaggi G, et al. Liver transplantation for severe hepatic trauma: experience from a single center. World J Gastroenterol. 2009;15:1641-1644.
Anderson IB, Kortbeek JB, Al-Saghier M, et al. Liver transplantation in severe hepatic trauma after hepatic artery embolization. J Trauma. 2005;58:848-851.
Veroux M, Madia C, Cillo U, et al. Long-term follow-up after liver transplantation for blunt hepatic trauma. Transplant Proc. 2002;34:1226-1228.
Tucker ON, Marriott P Rela M, et al. Emergency liver transplantation fol-lowing severe liver trauma. Liver Transpl. 2008;14:1204-1210.
Catalano G, De Simone P Montin U, et al. Severe liver trauma: the trans-plant surgeon's perspective. A case report. Hepatogastroenterology. 2008;55:1458-1459.
Jeng LB, Hsu CH, Wang CS, et al. Emergent liver transplantation to sal-vage a hepatic avulsion injury with a disrupted suprahepatic vena cava. Arch Surg. 1993;128:1075-1077.
Heuer M, Kaiser GM, Lendemans S, et al. Transplantation after blunt traumato the liver: a valuable option or just a "waste of organs?". Eur J Med Res. 2010;15:169-173.
Honoré C, Deroover A, Gilson N, et al. Liver transplantation for hepatic trauma: discussion about a case and its management. J Emerg Trauma Shock. 2011;4:137-139.
Domínguez Fernández E, Lange K, Lange R, et al. Relevance of two-stage total hepatectomy and liver transplantation in acute liver failure and severe liver trauma. Transpl Int. 2001;14:184-190.
Chiumello D, Gatti S, Caspani L, et al. A blunt complex abdominal trauma: total hepatectomy and liver transplantation. Intensive Care Med. 2002;28: 89-91.
Ginzburg E, Shatz D, Lynn M, et al. The role of liver transplantation in the subacute trauma patients. Am Surg. 1998;64:363-364.
Hatipoglu S, Bulbuloglu E, Ates M, et al. Liver transplantation following blunt liver trauma. Transplant Proc. 2012;44:1720-1721.
Belghiti J, Durand F Criteria for liver transplantation for hepatocellular carcinoma: what is an acceptable outcome? Liver Int. 2011;31 (Suppl 1): 161-163.
Clavien PA, Lesurtel M, Bossuyt PM, et al. Recommendations for liver transplantation for hepatocellular carcinoma: an international consensus conference report. Lancet Oncol. 2012;13:e11-e22.
Rana A, Gruessner A, Agopian VG, et al. Survival benefit of solid-organ transplant in the United States. JAMA Surg. 2015;150:252-259.
Biggins SW, Gralla J, Dodge JL, et al. Survival benefit of repeat liver trans-plantationin the United States:aserial MELD analysis byhepatitis C status and donor risk index. Am J Transplant. 2014;14:2588-2594.
Agopian VG, Petrowsky H, Kaldas FM, et al. The evolution of liver transplantation during3decades: analysis of5347 consecutive liver transplants at a single center. Ann Surg. 2013;258:409-421.
Stepanova M, Wai H, Saab S, et al. The outcomesof adult liver transplants in the United States from 1987 to 2013. Liver Int. 2015;35:2036-2041 doi: 10.1111/liv.12779.
Krawczyk M, Grat M, Barski K, et al. 1000 liver transplantations at the Department of General, Transplant and Liver Surgery, Medical University of Warsaw-analysis of indications and results. Pol Przegl Chir. 2012;84: 304-312.
Szoka N, Murray-Krezan C, Miskimins R, et al. Interhospital transfer of liver trauma in New Mexico: a state of austere resources. J Surg Res. 2014; 191:25-32.
Prichayudh S, Sirinawin C, Sriussadaporn S, et al. Management of liver injuries: predictors for the need ofoperation and damage control surgery. Injury. 2014;45:1373-1377.
Lin BC, Fang JF, Chen RJ, et al. Surgical management and outcome of blunt major liver injuries: experience of damage control laparotomy with perihepatic packing in one trauma centre. Injury. 2014;45: 122-127.
Sikhondze WL, Madiba TE, Naidoo NM, et al. Predictors of outcome in patients requiring surgery for liver trauma. Injury. 2007;38:65-70.
VanWagner LB, Lapin B, Levitsky J, et al. High early cardiovascular mortality after liver transplantation. Liver Transpl. 2014;20:1306-1316.
Rana A, Kaplan B, Jie T, et al. A critical analysis of early death after adult liver transplants. Clin Transplant. 2013;27:E448-E453.
Polanco P, Leon S, Pineda J, et al. Hepatic resection in the management of complex injury to the liver. J Trauma. 2008;65:1264-1269.
Rana A, Petrowsky H, Kaplan B, et al. Early liver retransplantation in adults. Transpl Int. 2014;27:141-151.
Fonouni H, Mehrabi A, Soleimani M, et al. The need for venovenous bypass in liver transplantation. HPB (Oxford). 2008;10:196-203.
Hoffmann K, Weigand MA, Hillebrand N, et al. Is veno-venous bypass still needed during liver transplantation? A review of the literature. Clin Transplant. 2009;23:1-8.
Grat M, Kornasiewicz O, Lewandowski Z, et al. The impact of surgical technique on the results of liver transplantation in patients with hepatocel-lular carcinoma. Ann Transplant. 2013;18:448-459.
Sakai T, Matsusaki T, Marsh JW, et al. Comparison of surgical methods in liver transplantation: retrohepatic caval resection with venovenous bypass (VVB) versus piggyback (PB) with VVB versus PB without VVB. Transpl Int. 2010;23:1247-1258.
Miyamoto S, Polak WG, Geuken E, et al. Liver transplantation with preservation of the inferior vena cava. A comparison of conventional and piggyback techniques in adults. Clin Transplant. 2004;18:686-693.
Kluger MD, Memeo R, Laurent A, et al. Survey of adult liver transplantation techniques (SALT): an international study of current practices in deceased donor liver transplantation. HPB (Oxford). 2011;13:692-698.
Weeks SR, Juillard CJ, Monono ME, et al. Is the Kampala trauma score an effective predictor of mortality in low-resource settings? A comparison of multiple trauma severity scores. World J Surg. 2014;38:1905-1911.
Haider AH, Hashmi ZG, Zafar SN, et al. Developing best practices to study trauma outcomes inlarge databases:an evidence-based approach to determine the best mortality risk adjustment model. J Trauma Acute Care Surg. 2014;76:1061-1069.
Füglistaler-Montali I, Attenberger C, Füglistaler P, et al. In search of benchmarking for mortality following multiple trauma: a Swiss trauma center experience. World J Surg. 2009;33:2477-2489.
Baker SP, O'Neill B, Haddon W Jr, et al. The injury severity score: a method for describing patients with multiple injuries and evaluating emergency care. J Trauma. 1974;14:187-196.
Ringe B, Pichlmayr R, Ziegler H, et al. Management of severe hepatic trauma by two-stage total hepatectomy and subsequent liver transplantation. Surgery. 1991;109:792-795.
Ringe B, Lübbe N, Kuse E, et al. Total hepatectomy and liver transplantation as two-stage procedure. Ann Surg. 1993;218:3-9.
Guirl MJ, Weinstein JS, Goldstein RM, et al. Two-stage total hepatectomy and liver transplantation for acute deterioration of chronic liver disease: a new bridge to transplantation. Liver Transpl. 2004;10:564-570.
Arora H, Thekkekandam J, Tesche L, et al. Long-term survival after 67 hours of anhepatic state due to primary liver allograft nonfunction. Liver Transpl. 2010;16:1428-1433.
