Intraoperative Management and Postoperative Outcome in Intestine-Inclusive Liver Transplantation Versus Liver Transplantation

• Perioperative management of intestine-inclusive liver transplantation (IILT) is poorly known.
• Compared with isolated liver transplantation patients, IILT patients were more prone to develop intraoperative complications and adverse outcomes.
• IILT patients should be closely monitored and aggressively managed.

BackgroundAlthough intestine-inclusive liver transplantation (IILT) is performed regularly, its perioperative management has not been studied extensively.MethodsPatients who underwent IILT and isolated liver transplantation (LT) at our center from January 2006 to December 2012 were identified. Among >1,000 LT patients, 90 were selected after matching by age, sex, surgery date, and status of preoperative ventilation for comparison with 45 IILT patients.ResultsThere were no significant differences regarding preoperative variables between the 2 groups except for international normalized ratio. However, IILT patients had significantly higher intraoperative requirement of blood transfusion, incidences of post-reperfusion syndrome, and hyperkalemia compared with LT patients. Postoperatively, IILT patients had significantly longer hospital stay and higher 1-year mortality. Multivariate analysis indicated that IILT was a primary risk factor associated with the studied complications and adverse outcomes.ConclusionsOur findings suggest that, compared with LT patients, IILT patients were more prone to develop intraoperative complications and adverse outcomes and should be closely monitored and aggressively managed.