Open AccessEarly post‐liver transplant surgical morbidity in HIV ‐infected recipients: risk factor for overall survival? A nationwide retrospective study
Author(s) -
Baccarani Umberto,
Pravisani Riccardo,
Isola Miriam,
Mocchegiani Federico,
Lauterio Andrea,
Righi Elda,
Magistri Paolo,
Corno Vittorio,
Adani Gian Luigi,
Lorenzin Dario,
Di Sandro Stefano,
Pagano Duilio,
Bassetti Matteo,
Gruttadauria Salvatore,
Colledan Michele,
De Carlis Luciano,
Vivarelli Marco,
Di Benedetto Fabrizio,
Risaliti Andrea
Publication year - 2019
Publication title -
transplant international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.998
H-Index - 82
eISSN - 1432-2277
pISSN - 0934-0874
DOI - 10.1111/tri.13446
Subject(s) - medicine , liver transplantation , retrospective cohort study , surgery , perforation , risk factor , portal hypertension , ascites , transplantation , gastroenterology , cirrhosis , punching , materials science , metallurgy
Summary The aim of the study was to analyse the risk factors for early surgical complications requiring relaparotomy and the related impact on overall survival ( OS ) in HIV ‐infected patients submitted to liver transplantation. Thus a retrospective investigation was conducted on a nationwide multicentre cohort of 157 HIV patients submitted to liver transplantation in six Italian Transplant Units between 2004 and 2014. An early relaparotomy was performed in 24.8% of cases and the underlying clinical causes were biliary leak (8.2%), bleeding (8.2%), intestinal perforation (4.5%) and suspect of vascular complications(3.8%). No differences in terms of prevalence for either overall or cause‐specific early relaparotomies were noted when compared with a non‐ HIV control group, matched for MELD , recipient age, HCV ‐ RNA positivity and HBV prevalence. While in the control group an early relaparotomy appeared a negative prognostic factor, such impact on OS was not noted in HIV recipients. Nonetheless increasing number of relaparotomies were associated with decreased survival. In multivariate analysis, preoperative refractory ascites and Roux‐en‐Y choledochojejunostomy reconstruction were significant risk factors for early relaparotomy. To conclude, in HIV liver transplanted patients, an increasing number of early relaparotomies because of surgical complications does negatively affect the OS . Preoperative refractory ascites reflecting a severe portal hypertension and a difficult biliary tract reconstruction requiring a Roux‐en‐Y choledochojejunostomy are associated with increased risk of early relaparotomy.