title: Extended criteria donor and severe intraoperative glucose variability: association with reoperation for hemorrhage in liver transplantation.
abstract: Reoperations for hemorrhage following liver transplantation (OLT) are commonly associated with increased morbidity and mortality. We sought to determine the incidence and risk factors for reoperation for hemorrhage among adult liver transplantations. We retrospectively analyzed 668 patients transplanted between January 2004 and November 2007. Within 30 days following transplantation one hundred eleven patients (16.6%) underwent 156 reoperations for hemorrhage, averaging 1.4 reoperations per patient. More than half of the reoperations occurred during the first 2 postoperative days. One-third of patients required 2 or more reoperations. Multivariate logistic regression analysis showed 4 independent risk factors: grafts from donors with multiple extended criteria, severe intraoperative glucose variability, intraoperative use of vasopressors, and red blood cell transfusion requirement. In conclusion, we identified several independent risk factors for reoperation due to hemorrhage following OLT. Avoidance of severe intraoperative glucose variability and careful evaluation of the benefits and risks of utilizing extended criteria donors must be considered before transplantation.
authors.affiliation: Department of Anesthesiology, David Geffen School of Medicine at UCLA, Los Angeles, California 90095-7403, USA.
authors.forename: C
authors.initials: C
authors.lastname: Park
authors.forename: M
authors.initials: M
authors.lastname: Huh
authors.forename: R H
authors.initials: RH
authors.lastname: Steadman
authors.forename: R
authors.initials: R
authors.lastname: Cheng
authors.forename: K Q
authors.initials: KQ
authors.lastname: Hu
authors.forename: D G
authors.initials: DG
authors.lastname: Farmer
authors.forename: J
authors.initials: J
authors.lastname: Hong
authors.forename: J
authors.initials: J
authors.lastname: Duffy
authors.forename: R W
authors.initials: RW
authors.lastname: Busuttil
authors.forename: V W
authors.initials: VW
authors.lastname: Xia
mesh_terms: D000328:Adult; D000367:Age Factors; D001786:Blood Glucose / Q000378:metabolism*; D006470:Hemorrhage / Q000209:etiology* / Q000601:surgery; D006801:Humans; D015994:Incidence; D016030:Kidney Transplantation / Q000379:methods; D016031:Liver Transplantation / Q000009:adverse effects* / Q000379:methods / Q000502:physiology; D008875:Middle Aged; D018579:Patient Selection; D011183:Postoperative Complications / Q000453:epidemiology / Q000601:surgery; D011446:Prospective Studies; D012086:Reoperation / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D014019:Tissue Donors / Q000706:statistics & numerical data*
chemical_list: D001786:Blood Glucose