Early post-liver transplant surgical morbidity in HIV-infected recipients: risk factor for overall survival? A nationwide retrospective study

Umberto Baccarani, Riccardo Pravisani, Miriam Isola, Federico Mocchegiani, Andrea Lauterio, Elda Righi, Paolo Magistri, Vittorio Corno, Gian Luigi Adani, Dario Lorenzin, Stefano Di Sandro, Duilio Pagano, Matteo Bassetti, Salvatore Gruttadauria, Michele Colledan, Luciano De Carlis, Marco Vivarelli, Fabrizio Di Benedetto, Andrea Risaliti

Research output: Contribution to journalArticlepeer-review

Abstract

The aim of the study was to analyse the risk factors for early surgical complications requiring relaparotomy and the related impact on overall survival (OS) in HIV-infected patients submitted to liver transplantation. Thus a retrospective investigation was conducted on a nationwide multicentre cohort of 157 HIV patients submitted to liver transplantation in six Italian Transplant Units between 2004 and 2014. An early relaparotomy was performed in 24.8% of cases and the underlying clinical causes were biliary leak (8.2%), bleeding (8.2%), intestinal perforation (4.5%) and suspect of vascular complications(3.8%). No differences in terms of prevalence for either overall or cause-specific early relaparotomies were noted when compared with a non-HIV control group, matched for MELD, recipient age, HCV-RNA positivity and HBV prevalence. While in the control group an early relaparotomy appeared a negative prognostic factor, such impact on OS was not noted in HIV recipients. Nonetheless increasing number of relaparotomies were associated with decreased survival. In multivariate analysis, preoperative refractory ascites and Roux-en-Y choledochojejunostomy reconstruction were significant risk factors for early relaparotomy. To conclude, in HIV liver transplanted patients, an increasing number of early relaparotomies because of surgical complications does negatively affect the OS. Preoperative refractory ascites reflecting a severe portal hypertension and a difficult biliary tract reconstruction requiring a Roux-en-Y choledochojejunostomy are associated with increased risk of early relaparotomy.

Original languageEnglish
Pages (from-to)1044-1052
Number of pages9
JournalTransplant International
Volume32
Issue number10
DOIs
Publication statusPublished - Oct 1 2019

Keywords

  • complications
  • human immunodeficiency virus
  • liver transplantation
  • relaparotomy

ASJC Scopus subject areas

  • Transplantation

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