Does previous abdominal surgery alter the outcome of pediatric patients subjected to orthotopic liver transplantation?

Abstract

The medical, anesthesia, and surgical records of 89 consecutive pediatric patients who underwent an orthotopic hepatic transplantation procedure at the University of Pittsburgh from February 1981 to May 1984 were reviewed to evaluate the effect of prior abdominal surgery upon the morbidity and mortality of orthotopic liver transplantation in children. Fifty-seven children (group 1) had had prior abdominal surgery, whereas 32 (group 2) had not. The group 1 subjects were younger (p less than 0.001), had better prothrombin times (p less than 0.01), and better platelet counts (p less than 0.02) than did those in group 2. No difference in the duration of anesthesia or intraoperative use of fresh frozen plasma or platelets was evident between the two groups. However, group 1 patients were given more red blood cells intraoperatively than were the group 2 patients (p less than 0.01). The group 1 patients had more total postoperative infections (p less than 0.05), which was due solely to a greater number of abdominal infections (p less than 0.05), but similar total hospital and intensive care unit stays as did the group 2 patients. When those in group 1 were divided into those having a previous Kasai procedure versus those who did not, no differences between the two groups were apparent except for age. Based upon these data, we conclude that prior abdominal surgery does not affect mortality, the duration of hospital or intensive care unit stay, plasma or platelet requirements, and total anesthesia time required for orthotopic liver transplantation, but does enhance the number of red blood cell transfusions and infections, particularly abdominal infections, in children undergoing this procedure.

Figures

Figure 1

Actuarial survival curves for the three groups of patients studied. Group 1A, those who had a prior Kasai procedure; group 1B, those who had prior abdominal surgery not including a Kasai procedure; and group 2, those without any prior surgery. No differences in survival are noted between the three groups for a period of 30 mo since the performance of the OLTx surgery.