title: The causes, risk factors, and outcomes of early relaparotomy after living-donor liver transplantation.
abstract: BACKGROUND
  Although early relaparotomy of the recipient after living-donor liver transplantation (LDLT) is a significant event, its causes, risk factors, and outcomes are still unclear.
  
  
  METHODS
  A retrospective analysis of 284 cases of adult-to-adult LDLT was performed.
  
  
  RESULTS
  The incidence of early relaparotomy of the recipient was 9.2% (n=26). The reasons for relaparotomy were divided into three groups: postoperative bleeding (n=11, 42.3%), insufficient portal venous flow (n=5, 19.2%), and other (n=10, 38.5%). The 6-month graft survival rates of patients in the early laparotomy and nonlaparotomy groups were 61.5% and 88.4%, respectively (P<0.0001). Patients with postoperative bleeding experienced a significantly higher mortality rate (54.6%) than those with other reasons for early relaparotomy (13.3%; P=0.0231). Multivariate analysis showed that a model for end-stage liver disease score of greater than 20 (odds ratio [OR], 9.06; P=0.0434) and an operative blood loss of greater than 15 L (OR, 9.06; P=0.0434) were significant risk factors for graft loss after early relaparotomy. In patients with patent major shunt vessels (>1 cm in diameter, n=31), portal venous flow of less than 1.0 L/min at the end of surgery was a significant risk factor for early relaparotomy to ligate the remaining shunt vessels (OR, 50.5; P=0.0188).
  
  
  CONCLUSIONS
  Early relaparotomy of the recipient is significantly associated with poor graft survival after LDLT. Massive intraoperative blood loss and high model for end-stage liver disease score were associated with poor graft survival in the relaparotomy group.
authors.affiliation: Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan. yoshiya@surg2.med.kyushu-u.ac.jp
authors.forename: Shohei
authors.initials: S
authors.lastname: Yoshiya
authors.forename: Ken
authors.initials: K
authors.lastname: Shirabe
authors.forename: Koichi
authors.initials: K
authors.lastname: Kimura
authors.forename: Tomoharu
authors.initials: T
authors.lastname: Yoshizumi
authors.forename: Toru
authors.initials: T
authors.lastname: Ikegami
authors.forename: Hiroto
authors.initials: H
authors.lastname: Kayashima
authors.forename: Takeo
authors.initials: T
authors.lastname: Toshima
authors.forename: Hideaki
authors.initials: H
authors.lastname: Uchiyama
authors.forename: Yuji
authors.initials: Y
authors.lastname: Soejima
authors.forename: Yoshihiko
authors.initials: Y
authors.lastname: Maehara
mesh_terms: D000328:Adult; D058625:End Stage Liver Disease / Q000150:complications* / Q000401:mortality / Q000601:surgery; D005260:Female; D006085:Graft Survival; D006801:Humans; D015994:Incidence; D007813:Laparotomy; D008099:Liver / Q000098:blood supply* / Q000601:surgery*; D016031:Liver Transplantation; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011169:Portal Vein / Q000502:physiology; D019106:Postoperative Hemorrhage / Q000150:complications* / Q000401:mortality / Q000601:surgery; D012039:Regional Blood Flow / Q000502:physiology; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome