title: Peri-hepatic gauze packing for the control of haemorrhage during liver transplantation: A retrospective study.
abstract: BACKGROUND
  Albeit accepted in the trauma setting, use of peri-hepatic gauze packing has been rarely reported during liver transplantation.
  
  
  OBJECTIVE
  To assess the results of packing in liver transplantation.
  
  
  METHODS
  We reviewed clinical characteristics, intraoperative events and postoperative outcome of consecutive adult liver transplantation recipients between 2003 and 2013. Patients treated with packing were compared to no-packing patients and to matched controls selected using a propensity score.
  
  
  RESULTS
  Of 1396 recipients, 107 were treated with packing for peri-hepatic bleeding (76.6%), allograft damage (12.1%) or partial outflow obstruction (11.2%). Urgent reoperation for ongoing haemorrhage was required in 6 (5.6%). Correction of haemodynamic and coagulation parameters was constantly achieved. Overall, patient (90% vs. 98%, p<0.001) and graft (83.2% vs. 94.7%, p<0.001) 3-month survival was significantly reduced in packing patients. However, after matching, no significant difference was observed in patient (89.3% vs. 95.2%, p=0.12) and graft (83.5% vs. 92.2%, p=0.06) 3-month survival. Patient survival was associated with recipient age (HR 2.59; p=0.04) and donor age × recipient MELD (HR 2.04; p=0.02), but not with packing (HR 1.81; p=0.29).
  
  
  CONCLUSIONS
  In our experience, packing was a valuable adjunct to conventional means of haemostasis during liver transplantation and, after accounting for confounding covariates, was not associated with inferior outcomes.
authors.affiliation: General Surgery 2U and Liver Transplantation Center, A.O.U. Città della Salute e della Scienza di Torino, University of Torino, Torino, Italy.
authors.forename: Damiano
authors.initials: D
authors.lastname: Patrono
authors.affiliation: General Surgery 2U and Liver Transplantation Center, A.O.U. Città della Salute e della Scienza di Torino, University of Torino, Torino, Italy. Electronic address: renato.romagnoli@unito.it.
authors.forename: Renato
authors.initials: R
authors.lastname: Romagnoli
authors.affiliation: General Surgery 2U and Liver Transplantation Center, A.O.U. Città della Salute e della Scienza di Torino, University of Torino, Torino, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Tandoi
authors.affiliation: General Surgery 2U and Liver Transplantation Center, A.O.U. Città della Salute e della Scienza di Torino, University of Torino, Torino, Italy.
authors.forename: Fabio
authors.initials: F
authors.lastname: Maroso
authors.affiliation: General Surgery 2U and Liver Transplantation Center, A.O.U. Città della Salute e della Scienza di Torino, University of Torino, Torino, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Bertolotti
authors.affiliation: Department of Clinical and Biological Sciences, University of Torino, Torino, Italy.
authors.forename: Paola
authors.initials: P
authors.lastname: Berchialla
authors.affiliation: General Surgery 2U and Liver Transplantation Center, A.O.U. Città della Salute e della Scienza di Torino, University of Torino, Torino, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Strignano
authors.affiliation: General Surgery 2U and Liver Transplantation Center, A.O.U. Città della Salute e della Scienza di Torino, University of Torino, Torino, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Brunati
authors.affiliation: General Surgery 2U and Liver Transplantation Center, A.O.U. Città della Salute e della Scienza di Torino, University of Torino, Torino, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Lupo
authors.affiliation: General Surgery 2U and Liver Transplantation Center, A.O.U. Città della Salute e della Scienza di Torino, University of Torino, Torino, Italy.
authors.forename: Mauro
authors.initials: M
authors.lastname: Salizzoni
mesh_terms: D000328:Adult; D005260:Female; D006085:Graft Survival; D006470:Hemorrhage / Q000517:prevention & control / Q000628:therapy*; D006488:Hemostasis, Surgical / Q000379:methods*; D006801:Humans; D007558:Italy; D053208:Kaplan-Meier Estimate; D016031:Liver Transplantation / Q000009:adverse effects*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009779:Occlusive Dressings; D011183:Postoperative Complications / Q000517:prevention & control / Q000628:therapy*; D012086:Reoperation; D012189:Retrospective Studies; D012720:Severity of Illness Index; D016896:Treatment Outcome
keywords: Damage control surgery; Haemorrhage; Liver transplantation; Open abdomen; Peri-hepatic gauze packing