Impact of Early Reoperation following Living-Donor Liver Transplantation on Graft Survival

Background: The reoperation rate remains high after liver transplantation and the impact of reoperation on graft and recipient outcome is unclear. The aim of our study is to evaluate the impact of early reoperation following living-donor liver transplantation (LDLT) on graft and recipient survival. Methods: Recipients that underwent LDLT (n = 111) at the University of Tokyo Hospital between January 2007 and December 2012 were divided into two groups, a reoperation group (n = 27) and a non-reoperation group (n = 84), and case-control study was conducted. Results: Early reoperation was performed in 27 recipients (24.3%). Mean time [standard deviation] from LDLT to reoperation was 10 [9.4] days. Female sex, Child-Pugh class C, Non-HCV etiology, fulminant hepatitis, and the amount of intraoperative fresh frozen plasma administered were identified as possibly predictive variables, among which females and the amount of FFP were identified as independent risk factors for early reoperation by multivariable analysis. The 3-, and 6-month graft survival rates were 88.9% (95% confidential intervals [CI], 70.7-96.4), and 85.2% (95% CI, 66.5-94.3), respectively, in the reoperation group (n = 27), and 95.2% (95% CI, 88.0-98.2), and 92.9% (95% CI, 85.0-96.8), respectively, in the non-reoperation group (n = 84) (the log-rank test, p = 0.31). The 12- and 36-month overall survival rates were 96.3% (95% CI, 77.9-99.5), and 88.3% (95% CI, 69.3-96.2), respectively, in the reoperation group, and 89.3% (95% CI, 80.7-94.3) and 88.0% (95% CI, 79.2-93.4), respectively, in the non-reoperation group (the log-rank test, p = 0.59). Conclusions: Observed graft survival for the recipients who underwent reoperation was lower compared to those who did not undergo reoperation, though the result was not significantly different. Recipient overall survival with reoperation was comparable to that without reoperation. The present findings enhance the importance of vigilant surveillance for postoperative complication and surgical rescue at an early postoperative stage in the LDLT setting.