Parenchymal liver injury in orthotopic liver transplantation

Background. A 35-year period of clinical development resulted in orthotopic liver transplantation (OLT) becoming a standardized surgical procedure. De spite this progress, the rate of technical complications is still high. Alt hough the main problem in most analyses is vascular or bile duct failure, w e observed a remarkable number of parenchymal liver injuries that led to in traoperative problems. Our aim, therefore, is to present an overall report on the incidence, treatment, and clinical course of parenchymal liver injur ies in OLT. Methods. Five hundred seventy-two consecutive OLT procedures performed betw een 1988 and 1998 were analyzed in a retrospective study. Parenchymal liver injury was diagnosed by means of examination of the surgical reports. Dono r- and recipient-related data followed the medical report. The lesions were classified according to the Organ Inquiry Scale. Results. Parenchymal liver injury was diagnosed in 23 patients (4%). The le sions were classified as grade Ia (13.1%), grade Ib (13.1%), grade IIb (52. 1%), grade IIIa (17.1%), and grade IIIb (4.3%), In 19 patients (82.6%), the lesion was detected during OLT, and in four patients (17.4%), during relap arotomy. The latter group showed significantly higher-grade injuries, Treat ment was suture or fibringlue alone, 17.4%; fibringlue and hemostyptics, 26 .1%, mesh wrapping 30.4%, and mesh packing 26.1%. Seven patients (30.4%) un derwent relaparotomy, Further active bleeding was not found in any of them, Statistical analysis found a correlation between injury grade and relaparo tomy rate. No patients died as a result of parenchymal liver injury. Conclusions. Parenchymal liver injuries can be treated well, with no advers e effect on patient or graft survival, An early decision concerning the sur gical procedure for controlling hemorrhage is required. A basically aggress ive therapeutic approach might avoid further complications relating to repe rfusion edema.