Subjective Difficulty Scale in Liver Transplantation: A Prospective Observational Study.

Abstract

The predictive value of a subjective difficulty scale (DS) after surgical procedures is unknown. The objective of this study was to evaluate the prognostic value of a DS after liver transplantation (LT) and to identify predictors of difficulty. Surgeons prospectively evaluated the difficulty of 441 consecutive liver transplantations from donation after brain death at the end of the surgery by using a DS from 0 to 10 ("the easiest to the hardest you can imagine"). DS was associated with severe morbidity. The risk of graft loss at 1 year remained unchanged from 0 to 6 but increased beyond 6. Graft survival and patient survival of group with DS 7-10 was significantly impaired compared to groups with DS: 0-3 or DS: 4-6 but were significantly impaired for the group with DS: 7-10. Independent predictors of difficult LT (DS ≥ 7) were annular segment 1, transjugular intrahepatic portosystemic shunt, retransplantation beyond 30 days, portal vein thrombosis, and ascites. Of them, ascites was a borderline non-significant covariate (p = .04). Vascular complications occurred more often after difficult LT (20.5% vs. 5.9%), whereas there was no difference in the other types of complications. DS can be used to tailor monitoring and anticipate early complications. External validation is needed.

• Authors: Yuki Kitano, Daniel Pietrasz, Elena Fernandez-Sevilla, Nicolas Golse, Eric Vibert, Antonio Sa Cunha, Daniel Azoulay, Daniel Cherqui, Hideo Baba, René Adam, Marc-Antoine Allard
• Journal: Transplant international : official journal of the European Society for Organ Transplantation (Transpl Int) Vol. 35 Pg. 10308 ( 2022) ISSN: 1432-2277 [Electronic] Switzerland
• PMID: 35387395 (Publication Type: Journal Article, Observational Study)
• Copyright: Copyright © 2022 Kitano, Pietrasz, Fernandez-Sevilla, Golse, Vibert, Sa Cunha, Azoulay, Cherqui, Baba, Adam and Allard.

Topics

• Ascites (complications)
• Humans
• Liver Cirrhosis (surgery)
• Liver Transplantation (adverse effects)
• Portal Vein (surgery)
• Portasystemic Shunt, Transjugular Intrahepatic (adverse effects, methods)
• Treatment Outcome