Liver transplantation for hepatic trauma: a study From the European Liver Transplant Registry

Marek Krawczyk; Michał Grąt; Rene Adam; Wojciech G Polak; Jurgen Klempnauer; Antonio Pinna; Fabrizio Di Benedetto; Franco Filipponi; Norbert Senninger; Aksel Foss; Sebastian Rufián-Peña; William Bennet; Johann Pratschke; Andreas Paul; Utz Settmacher; Giorgio Rossi; Mauro Salizzoni; Carlos Fernandez-Selles; Santiago T Martínez de Rituerto; Miguel A Gómez-Bravo; Jacques Pirenne; Olivier Detry; Pietro E Majno; Petr Nemec; Wolf O Bechstein; Michael Bartels; Silvio Nadalin; Francois R Pruvot; Darius F Mirza; Luigi Lupo; Michele Colledan; Giuseppe Tisone; Jan Ringers; Jorge Daniel; Ramón Charco Torra; Enrique Moreno González; Rafael Bañares Cañizares; Valentin Cuervas-Mons Martinez; Fernando San Juan Rodríguez; Sezai Yilmaz; Piotr Remiszewski; European Liver and Intestine Transplant Association (ELITA)

doi:10.1097/TP.0000000000001398

Liver transplantation for hepatic trauma: a study From the European Liver Transplant Registry

Marek Krawczyk, Michał Grąt, Rene Adam, Wojciech G Polak, Jurgen Klempnauer, Antonio Pinna, Fabrizio Di Benedetto, Franco Filipponi, Norbert Senninger, Aksel Foss, Sebastian Rufián-Peña, William Bennet, Johann Pratschke, Andreas Paul, Utz Settmacher, Giorgio Rossi, Mauro Salizzoni, Carlos Fernandez-Selles, Santiago T Martínez de Rituerto, Miguel A Gómez-BravoJacques Pirenne, Olivier Detry, Pietro E Majno, Petr Nemec, Wolf O Bechstein, Michael Bartels, Silvio Nadalin, Francois R Pruvot, Darius F Mirza, Luigi Lupo, Michele Colledan, Giuseppe Tisone, Jan Ringers, Jorge Daniel, Ramón Charco Torra, Enrique Moreno González, Rafael Bañares Cañizares, Valentin Cuervas-Mons Martinez, Fernando San Juan Rodríguez, Sezai Yilmaz, Piotr Remiszewski, European Liver and Intestine Transplant Association (ELITA)

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Abstract

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.

Original language	English
Pages (from-to)	2372-2381
Number of pages	10
Journal	Transplantation
Volume	100
Issue number	11
DOIs	https://doi.org/10.1097/TP.0000000000001398
Publication status	Published - Nov 2016

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Krawczyk, M., Grąt, M., Adam, R., Polak, W. G., Klempnauer, J., Pinna, A., Di Benedetto, F., Filipponi, F., Senninger, N., Foss, A., Rufián-Peña, S., Bennet, W., Pratschke, J., Paul, A., Settmacher, U., Rossi, G., Salizzoni, M., Fernandez-Selles, C., Martínez de Rituerto, S. T., ... European Liver and Intestine Transplant Association (ELITA) (2016). Liver transplantation for hepatic trauma: a study From the European Liver Transplant Registry. Transplantation, 100(11), 2372-2381. https://doi.org/10.1097/TP.0000000000001398

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title = "Liver transplantation for hepatic trauma: a study From the European Liver Transplant Registry",

abstract = "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.",

author = "Marek Krawczyk and Micha{\l} Gr{\c a}t and Rene Adam and Polak, {Wojciech G} and Jurgen Klempnauer and Antonio Pinna and {Di Benedetto}, Fabrizio and Franco Filipponi and Norbert Senninger and Aksel Foss and Sebastian Rufi{\'a}n-Pe{\~n}a and William Bennet and Johann Pratschke and Andreas Paul and Utz Settmacher and Giorgio Rossi and Mauro Salizzoni and Carlos Fernandez-Selles and {Mart{\'i}nez de Rituerto}, {Santiago T} and G{\'o}mez-Bravo, {Miguel A} and Jacques Pirenne and Olivier Detry and Majno, {Pietro E} and Petr Nemec and Bechstein, {Wolf O} and Michael Bartels and Silvio Nadalin and Pruvot, {Francois R} and Mirza, {Darius F} and Luigi Lupo and Michele Colledan and Giuseppe Tisone and Jan Ringers and Jorge Daniel and {Charco Torra}, Ram{\'o}n and {Moreno Gonz{\'a}lez}, Enrique and {Ba{\~n}ares Ca{\~n}izares}, Rafael and {Cuervas-Mons Martinez}, Valentin and {San Juan Rodr{\'i}guez}, Fernando and Sezai Yilmaz and Piotr Remiszewski and {European Liver and Intestine Transplant Association (ELITA)}",

year = "2016",

month = nov,

doi = "10.1097/TP.0000000000001398",

language = "English",

volume = "100",

pages = "2372--2381",

journal = "Transplantation",

issn = "0041-1337",

publisher = "Lippincott Williams and Wilkins",

number = "11",

}

Krawczyk, M, Grąt, M, Adam, R, Polak, WG, Klempnauer, J, Pinna, A, Di Benedetto, F, Filipponi, F, Senninger, N, Foss, A, Rufián-Peña, S, Bennet, W, Pratschke, J, Paul, A, Settmacher, U, Rossi, G, Salizzoni, M, Fernandez-Selles, C, Martínez de Rituerto, ST, Gómez-Bravo, MA, Pirenne, J, Detry, O, Majno, PE, Nemec, P, Bechstein, WO, Bartels, M, Nadalin, S, Pruvot, FR, Mirza, DF, Lupo, L, Colledan, M, Tisone, G, Ringers, J, Daniel, J, Charco Torra, R, Moreno González, E, Bañares Cañizares, R, Cuervas-Mons Martinez, V, San Juan Rodríguez, F, Yilmaz, S, Remiszewski, P & European Liver and Intestine Transplant Association (ELITA) 2016, 'Liver transplantation for hepatic trauma: a study From the European Liver Transplant Registry', Transplantation, vol. 100, no. 11, pp. 2372-2381. https://doi.org/10.1097/TP.0000000000001398

TY - JOUR

T1 - Liver transplantation for hepatic trauma

T2 - a study From the European Liver Transplant Registry

AU - Krawczyk, Marek

AU - Grąt, Michał

AU - Adam, Rene

AU - Polak, Wojciech G

AU - Klempnauer, Jurgen

AU - Pinna, Antonio

AU - Di Benedetto, Fabrizio

AU - Filipponi, Franco

AU - Senninger, Norbert

AU - Foss, Aksel

AU - Rufián-Peña, Sebastian

AU - Bennet, William

AU - Pratschke, Johann

AU - Paul, Andreas

AU - Settmacher, Utz

AU - Rossi, Giorgio

AU - Salizzoni, Mauro

AU - Fernandez-Selles, Carlos

AU - Martínez de Rituerto, Santiago T

AU - Gómez-Bravo, Miguel A

AU - Pirenne, Jacques

AU - Detry, Olivier

AU - Majno, Pietro E

AU - Nemec, Petr

AU - Bechstein, Wolf O

AU - Bartels, Michael

AU - Nadalin, Silvio

AU - Pruvot, Francois R

AU - Mirza, Darius F

AU - Lupo, Luigi

AU - Colledan, Michele

AU - Tisone, Giuseppe

AU - Ringers, Jan

AU - Daniel, Jorge

AU - Charco Torra, Ramón

AU - Moreno González, Enrique

AU - Bañares Cañizares, Rafael

AU - Cuervas-Mons Martinez, Valentin

AU - San Juan Rodríguez, Fernando

AU - Yilmaz, Sezai

AU - Remiszewski, Piotr

AU - European Liver and Intestine Transplant Association (ELITA)

PY - 2016/11

Y1 - 2016/11

N2 - 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.

AB - 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.

U2 - 10.1097/TP.0000000000001398

DO - 10.1097/TP.0000000000001398

M3 - Article

C2 - 27780185

SN - 0041-1337

VL - 100

SP - 2372

EP - 2381

JO - Transplantation

JF - Transplantation

IS - 11

ER -

Liver transplantation for hepatic trauma: a study From the European Liver Transplant Registry

Abstract

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