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Surgical Complications Requiring an Early Relaparotomy in HIV-Infected Liver Transplant Recipients: Risk Factors and Impact on Survival

Pravisani, Riccardo ; Baccarani, Umberto ; 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 ; De Carlis, Luciano ; Vivarelli, Marco ; Di Benedetto, Fabrizio ; Risaliti, Andrea

Transplantation proceedings, November 2019, Vol.51(9), pp.2977-2980 [Rivista Peer Reviewed]

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  • Titolo:
    Surgical Complications Requiring an Early Relaparotomy in HIV-Infected Liver Transplant Recipients: Risk Factors and Impact on Survival
  • Autore: Pravisani, Riccardo ; Baccarani, Umberto ; 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 ; De Carlis, Luciano ; Vivarelli, Marco ; Di Benedetto, Fabrizio ; Risaliti, Andrea
  • Note di contenuto: We aimed to analyze 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. We performed a retrospective study on a nationwide multicenter cohort of 157 HIV-infected patients submitted to liver transplantation in 6 Italian transplant units between 2004 to 2014. The median preoperative model for end-stage liver disease score was 18 (interquartile range 12-26.5). An early relaparotomy was performed in 24.8% of patients, and the underlying clinical causes were biliary leak (8.2%), bleeding (8.2%), intestinal perforation (4.5%), and suspected vascular complications (3.8%). The OS at 1, 3, and 5 years was 74.3%, 68.0%, and 60.0%, respectively, and an early relaparotomy was not a prognostic factor itself, but an increasing number of relaparotomies was associated with decreased survival (hazard ratio = 1.40, 95% confidence interval [CI] 1.07-1.81, P = .01). In the multivariate analysis, preoperative refractory ascites (odds ratio 3.32, 95% CI 1.18-6.47, P = .02) and Roux-en-Y choledochojejunostomy reconstruction (odds ratio 12.712, 95% CI 2.47-65.38, P ≤ .01) were identified as significant risk factors for early relaparotomy. In HIV-infected liver transplant recipients, an increasing number of early relaparotomies due to surgical complications did negatively affect the OS. Preoperative refractory ascites reflecting a severe portal hypertension and a difficult biliary tract reconstruction requiring a Roux-en-Y choledochojejunostomy were associated with an increased risk of early relaparotomy.
  • Fa parte di: Transplantation proceedings, November 2019, Vol.51(9), pp.2977-2980
  • Soggetti: Liver Transplantation ; HIV Infections -- Complications ; Postoperative Complications -- Surgery ; Reoperation -- Mortality
  • Lingua: Inglese
  • Tipo: Articolo
  • Identificativo: E-ISSN: 1873-2623 ; PMID: 31607626 Version:1 ; DOI: 10.1016/j.transproceed.2019.03.085

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