Gastroenterology 1986 Apr;90(4):853-7

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

Cuervas-Mons V, Rimola A, Van Thiel DH, Gavaler JS, Schade RR, Starzl TE

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