title: Rescue management of early complications after liver transplantation-key for the long-term success.
abstract: OBJECTIVE
  Postoperative complications may have not only immediate but also long-term effects on the outcomes. Here, we analyzed the effect of postoperative complications requiring a reoperation (grade 3b) within the first 30 days on patients' and graft survival following liver transplantation.
  
  
  METHODS
  Graft and patient survival in relation to donor and recipient variables and the need of reoperation for complications of 277 consecutive liver transplants performed from January 2007 to December 2012 were analyzed.
  
  
  RESULTS
  Two hundred seventy-seven liver transplants were performed in 252 patients. Overall patient and graft survival at 1, 2, and 3 years were significantly reduced in patients requiring a reoperation. The labMELD score was significantly elevated (p = 0.04) and cold ischemia time was prolonged (p = 0.03) in recipients undergoing reoperations. Kaplan-Meier curves indicate that complications impact the outcome primarily within the first 3 months after transplantation. In multivariate analyses, the actual need of reoperation (p < 0.001), the labMELD score (p = 0.05), cold ischemia time (p = 0.02), and the need for hemodialysis pre-transplant (p = 0.05) were the only variables which correlated with the overall survival.
  
  
  CONCLUSIONS
  Postoperative complications resulting in reoperations have a significant impact on the outcome primarily in the early phase after liver transplantation. Successful management of postoperative complications is key to every successful liver transplant program.
authors.affiliation: Department of General, Visceral, and Transplant Surgery, Ludwig Maximilian University, Munich, Germany. joachim.andrassy@med.uni-muenchen.de.
authors.forename: Joachim
authors.initials: J
authors.lastname: Andrassy
authors.affiliation: Department of General, Visceral, and Transplant Surgery, Ludwig Maximilian University, Munich, Germany.
authors.forename: Sebastian
authors.initials: S
authors.lastname: Wolf
authors.affiliation: Institute of Medical Information Sciences, Biometry and Epidemiology (IBE), Ludwig Maximilian University, Munich, Germany.
authors.forename: Verena
authors.initials: V
authors.lastname: Hoffmann
authors.affiliation: Department of General, Visceral, and Transplant Surgery, Ludwig Maximilian University, Munich, Germany.
authors.forename: Markus
authors.initials: M
authors.lastname: Rentsch
authors.affiliation: Department of General, Visceral, and Transplant Surgery, Ludwig Maximilian University, Munich, Germany.
authors.forename: Manfred
authors.initials: M
authors.lastname: Stangl
authors.affiliation: Department of General, Visceral, and Transplant Surgery, Ludwig Maximilian University, Munich, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Thomas
authors.affiliation: Department of General, Visceral, and Transplant Surgery, Ludwig Maximilian University, Munich, Germany.
authors.forename: Sebastian
authors.initials: S
authors.lastname: Pratschke
authors.affiliation: Department of Anesthesiology, Ludwig Maximilian University, Munich, Germany.
authors.forename: Lorenz
authors.initials: L
authors.lastname: Frey
authors.affiliation: Department of Medicine, MED II, Ludwig Maximilian University, Munich, Germany.
authors.forename: Alexander
authors.initials: A
authors.lastname: Gerbes
authors.affiliation: Transplant Center, Ludwig Maximilian University, Munich, Germany.
authors.forename: Bruno
authors.initials: B
authors.lastname: Meiser
authors.affiliation: Department of General, Visceral, and Transplant Surgery, Ludwig Maximilian University, Munich, Germany.
authors.forename: Martin
authors.initials: M
authors.lastname: Angele
authors.affiliation: Department of General, Visceral, and Transplant Surgery, Ludwig Maximilian University, Munich, Germany.
authors.forename: Jens
authors.initials: J
authors.lastname: Werner
authors.affiliation: Department of General, Visceral, and Transplant Surgery, Ludwig Maximilian University, Munich, Germany.
authors.forename: Markus
authors.initials: M
authors.lastname: Guba
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D058625:End Stage Liver Disease / Q000401:mortality / Q000601:surgery*; D005260:Female; D006085:Graft Survival; D006801:Humans; D016031:Liver Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy*; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
keywords: Liver transplantation; Postoperative complications; Rescue management