title: Surgical complications after liver transplantation.
abstract: OBJECTIVE
  The number of liver transplantations in Italy has steadily increased over the last 10 years as a result of the use of donors aged more than 60 years. The use of organs with a reduced functional reserve has been compensated for by improvements in immunosuppressive therapy, surgical techniques and the management of postoperative complications. This article describes the incidence and treatment of the main surgical complications after liver transplantation.
  
  
  METHODS
  Between January 1996 and June 2003, 398 patients received 430 transplants at our Centre. Thirty-seven early relaparotomies were performed (8.6%), including 12 retransplantation (2.8%). The 1-, 3- and 5-year actuarial survival of the patients was 79.8%, 72.2% and 67.5%, and that of the grafts was 75.9%, 68% and 63.4%. Perioperative mortality was 10.5% (with no intraoperative deaths).
  
  
  RESULTS
  The overall incidence of biliary complications was 31.6%, 9.1% of which were due to the removal of the Kehr tube. There were 42 (9.8%) anastomotic stenoses, 5 (1.2%) extra-anastomotic stenoses, 1 (0.2%) anastomotic leak, 5 (1.2%) extra-anastomotic leaks, and 19 (4.4%) ischemic-type biliary lesions. The overall incidence of vascular complications was 6.9%: 7 (1.6%) cases of hepatic artery thrombosis, 17 (4.0%) arterial stenoses, 1 (0.2%) arterial pseudoaneurysm, 4 (0.9%) cases of portal thromboses and 1 (0.2%) case of caval laminar thrombosis. Eight patients (1.9%) developed massive and persistent post-transplant ascites and/or hydrothorax.
  
  
  CONCLUSIONS
  The use of donors aged more than 60 years makes it possible to maintain high standards of patient and graft survival that is not only due to the optimisation of immunosuppressive protocols, but also to improvements in surgical techniques, intensive care and the management of surgical complications.
authors: Liver Transplant Unit, University of Pisa, Pisa, Italy.
authors: L
authors: L
authors: Urbani
authors: G
authors: G
authors: Catalano
authors: G
authors: G
authors: Biancofiore
authors: L
authors: L
authors: Bindi
authors: G
authors: G
authors: Consani
authors: M
authors: M
authors: Bisà
authors: A
authors: A
authors: Boldrini
authors: A
authors: A
authors: Campatelli
authors: S
authors: S
authors: Signori
authors: L
authors: L
authors: Morelli
authors: L
authors: L
authors: Coletti
authors: V
authors: V
authors: Perrone
authors: C
authors: C
authors: Vignali
authors: R
authors: R
authors: Cioni
authors: P
authors: P
authors: Petruzzi
authors: P
authors: P
authors: Boraschi
authors: D
authors: D
authors: Campani
authors: F
authors: F
authors: Mosca
authors: F
authors: F
authors: Filipponi
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001660:Biliary Tract Diseases / Q000453:epidemiology; D005260:Female; D006801:Humans; D015994:Incidence; D016031:Liver Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology / Q000628:therapy; D012086:Reoperation; D015996:Survival Rate; D014652:Vascular Diseases / Q000453:epidemiology