title: Long-term outcome analysis of liver transplantation for severe hepatic trauma.
abstract: BACKGROUND
  Liver transplantation (LTX) for severe hepatic trauma and its sequelae is a rare but potentially lifesaving option at the far end of the operative spectrum.
  
  
  METHODS
  This study analyzes 12 cases with LTX for hepatic trauma and its consequences from two transplant centers. A total of 2,701 consecutive liver transplants unrelated to trauma served as a control group. χ and Mann-Whitney U-tests, Kaplan-Meier analysis with log-rank tests, and Cox regression analysis were applied. Addressed were issues before, during, and after LTX. Major study end points were patient and graft survival.
  
  
  RESULTS
  The posttrauma transplant recipients are significantly younger (p = 0.014), with a significantly shorter graft survival (p = 0.038), resulting in a significantly higher retransplantation rate (p = 0.043). Of the 12 patients, 11 underwent surgical treatment for hepatic trauma before LTX with 7 of 12 patients experiencing liver necrosis at the time of LTX. Short-term survival and long-term survival are not significantly different between trauma and nontrauma patients. Severity of liver trauma (Moore Score) and concomitant injuries (Injury Severity Score [ISS]) have no significant impact on patient and graft survival. Four patients with hepatic trauma were treated with two-stage LTX with anhepatic phases between 14 hours and 28 hours. Two of those patients reached long-term survival (20-22 years).
  
  
  CONCLUSIONS
  LTX for severe liver trauma and its consequences seems justified in extreme cases. The high frequency of liver necrosis at the time of LTX may indicate possible shortcomings in liver packing technique or liver resection for hemorrhage control. Thus, severe hepatic trauma requires treatment by experienced liver surgeons and emergency physicians.
  
  
  METHODS
  Therapeutic study, level IV.
authors.affiliation: From the Department of General, Visceral and Transplantation Surgery (A.K., C.M.B., F.L., J.K., H.S.), Hannover Medical School; Federal Armed Forces Medical Center (A.K.), Hannover; and General and Thoracic Surgery (B.R., T.B.), University Hospital Schleswig Holstein, Kiel, Germany.
authors.forename: Alexander
authors.initials: A
authors.lastname: Kaltenborn
authors.forename: Benedikt
authors.initials: B
authors.lastname: Reichert
authors.forename: Catherine M
authors.initials: CM
authors.lastname: Bourg
authors.forename: Thomas
authors.initials: T
authors.lastname: Becker
authors.forename: Frank
authors.initials: F
authors.lastname: Lehner
authors.forename: Jürgen
authors.initials: J
authors.lastname: Klempnauer
authors.forename: Harald
authors.initials: H
authors.lastname: Schrem
mesh_terms: D000007:Abdominal Injuries / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D000293:Adolescent; D000328:Adult; D002648:Child; D005260:Female; D005500:Follow-Up Studies; D005544:Forecasting; D005858:Germany; D006498:Hepatectomy / Q000379:methods; D006801:Humans; D053208:Kaplan-Meier Estimate; D008099:Liver / Q000293:injuries* / Q000601:surgery; D016031:Liver Transplantation / Q000379:methods* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D012086:Reoperation; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D015599:Trauma Severity Indices; D055815:Young Adult