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

BackgroundAlbeit accepted in the trauma setting, use of peri-hepatic gauze packing has been rarely reported during liver transplantation.AimsTo assess the results of packing in liver transplantation.MethodsWe 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.ResultsOf 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).ConclusionsIn 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.