title: Surgical complications in human orthotopic liver transplantation.
abstract: Between March 1, 1980 and December 31, 1984, 393 orthotopic liver transplantations (OLT) were performed in 313 consecutive recipients. Technical complications were responsible for a substantial morbidity (41/393 allograft loss--10.4%) and mortality (26/313 patient loss--8.3%). Failure of the biliary tract reconstruction, mainly expressed as leakage and obstruction, is the most frequent complication of OLT (52/393 grafts--13.2%). Biliary tract complication (BTC) was directly responsible for 5 deaths (9.6%). Reliance upon standardized methods of direct duct-to duct repair with T-tube (CC-T) and Roux-Y choledocho-jejunostomy (RYCH-J), appropriate postoperative investigation and treatment will reduce morbidity and mortality of BTC. A complicated CC-T will be conversed to a RYCH-J; a complicated RYCH-J needs surgical correction. Hepatic artery thrombosis (HAT) has become the "Achilles heel" of OLT. HAT is expressed by three different patterns: fulminant hepatic necrosis, delayed bile leakage and relapsing bacteremia. Diagnosed in 27 grafts (6.8%), HAT was responsible for 16 deaths (16/25 pat: 64%). The only chance to rescue patients presenting HAT is an early diagnosis and prompt retransplantation before occurrence of septic complications. Aneurysm of the hepatic arterial supply (4/393 grafts--1%) also needs aggressive surgery because of the high rate of fatal rupture (3/4 pat--75%). The incidence of thrombosis of the reconstructed portal vein (PVT) was only 2.2% (7 pat.), three inferior vena caval thromboses (0.9%) (CVT) were diagnosed after OLT. Four of the 7 patients whose portal veins clotted are alive. Three have their original graft. One patient, presenting both PVT and CVT, was rescued by prompt retransplantation. PVT was responsible for 3 patient (3/7 pat--42.8%) and 4 graft losses (4/7 pat--57%). The rate of graft (3/3) and patient loss (2/3) was even higher after CVT.
authors.forename: J
authors.initials: J
authors.lastname: Lerut
authors.forename: R D
authors.initials: RD
authors.lastname: Gordon
authors.forename: S
authors.initials: S
authors.lastname: Iwatsuki
authors.forename: T E
authors.initials: TE
authors.lastname: Starzl
mesh_terms: D000783:Aneurysm / Q000209:etiology; D001660:Biliary Tract Diseases / Q000209:etiology; D006502:Budd-Chiari Syndrome / Q000209:etiology; D006499:Hepatic Artery; D006801:Humans; D016031:Liver Transplantation; D011169:Portal Vein; D011183:Postoperative Complications / Q000209:etiology* / Q000401:mortality; D013927:Thrombosis / Q000209:etiology; D014682:Vena Cava, Inferior