BACKGROUND: Albeit accepted in the trauma setting, use of peri-hepatic gauze packing has been rarely reported during liver transplantation. AIMS: 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.

Peri-hepatic gauze packing for the control of haemorrhage during liver transplantation: A retrospective study

PATRONO, Damiano;ROMAGNOLI, Renato
;
TANDOI, FRANCESCO;BERTOLOTTI, GIOVANNI;BERCHIALLA, Paola;STRIGNANO, Paolo;BRUNATI, ANDREA;SALIZZONI, Mauro
2016

Abstract

BACKGROUND: Albeit accepted in the trauma setting, use of peri-hepatic gauze packing has been rarely reported during liver transplantation. AIMS: 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.
48
4
414
422
http://www.elsevier.com/wps/find/journalbibliographicinfo.cws_home/623449/description#bibliographicinfo
Damage control surgery, Haemorrhage, Liver transplantation, Open abdomen, Peri-hepatic gauze packing
Patrono, Damiano; Romagnoli, Renato; Tandoi, Francesco; Maroso, Fabio; Bertolotti, Giovanni; Berchialla, Paola; Strignano, Paolo; Brunati, Andrea; Lupo, Francesco; Salizzoni, Mauro
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/2318/1560163
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