Transplantation after blunt trauma to the liver: a valuable option or just a "waste of organs"?
OBJECTIVE
Liver injury due to trauma is a rare indication for transplantation. The main indications in such cases were uncontrollable bleeding and insufficient hepatic function. Because of poor results, liver transplantation in these patients is occasionally described as "waste of organs", however based on insufficient data. This study aims to report our experience and to critically question the indication of transplantation in these patients.


METHODS
All liver transplantations at our institution were reviewed retrospectively. This covered 1,529 liver transplants between September 1987 and December 2008. Of them, 6 transplants were performed due to motor-vehicle accidents which caused uncontrollable acute liver trauma in 4 patients. The patients' peri-operative course, short- and long-term outcomes were analyzed.


RESULTS
Five deceased-donor liver transplantations (4 full size, 1 split) and 1 living donor (right) transplantation were performed. The median GCS score was 9/15; the median MELD score was 15. Postoperative complications were observed in 3 patients, requiring re-operation in 2. After a median (range) follow-up of 32.95 (10.3-55.6) months, 2 patients are alive and remain well on immunosuppression.


CONCLUSIONS
Liver transplantation in patients with otherwise surgically uncontrollable acute liver injury can be indicated as a life saving procedure and can be performed successfully in highly selected cases.
Heuer
Matthias
M
Department of General-, Visceral- and Transplantation Surgery, University Hospital of Essen, Hufelandstrasse 55, 45122 Essen, Germany. matthias.heuer@uk-essen.de
Kaiser
G M
GM
Lendemans
S
S
Vernadakis
S
S
Treckmann
J W
JW
Paul
A
A
D000007:Abdominal Injuries / Q000601:surgery*; D000063:Accidents, Traffic; D000328:Adult; D002102:Cadaver; D017809:Fatal Outcome; D005260:Female; D006085:Graft Survival; D006406:Hematoma / Q000209:etiology / Q000601:surgery*; D006801:Humans; D008099:Liver / Q000293:injuries*; D016031:Liver Transplantation / Q000379:methods*; D008297:Male; D008875:Middle Aged; D012086:Reoperation; D012189:Retrospective Studies; D014019:Tissue Donors; D016896:Treatment Outcome; D014949:Wounds, Nonpenetrating / Q000601:surgery*