N.C. Charland1, K. Maeda2, V. Ripa2, M. Ha1, S.S. Ebaid1,2, V.G. Agopian1,2, D.G. Farmer1,2, F.M. Kaldas1,2 1David Geffen School Of Medicine, University Of California At Los Angeles, Los Angeles, CA, USA 2University Of California – Los Angeles, Department Of Surgery, Division Of Liver And Pancreatic Transplantation, Los Angeles, CA, USA
Introduction:
Prior abdominal surgery (PAS) is a known risk factor for inferior outcomes following liver transplant (LT). LT patients with complex surgical abdomens have been primarily risk-stratified based on anatomic location of prior interventions, comparing patients with “upper abdominal” (up to and including the hepatic flexure of the colon) and “lower abdominal” surgical histories. Data comparing the respective risk profiles of prior gastrointestinal tract and solid organ interventions remain limited.
Methods:
This was a retrospective analysis of all adult (≥18 years) LT recipients at a single academic medical center from 2012-2022. Patients with a history of major abdominal surgery preceding liver transplantation were retained for analysis. Patients with a history of isolated gynecologic surgery and those missing key data (0.3%) were excluded. Patients with prior gastric, small or large bowel, gallbladder, and appendix interventions were included in the HOS (Hollow Organ Surgery) cohort, while patients with a history of solid organ surgery involving the liver, spleen, or pancreas were classified as SOS (Solid Organ Surgery). Patients meeting inclusion criteria for both cohorts were not retained for analysis. Multivariate regression models were developed to characterize the association of PAS subtype and posttransplant outcomes, with covariates selected on the basis of clinical relevance. Kaplan-Meier analysis was utilized to evaluate differences in long-term patient and graft survival between cohorts.
Results:
Of 488 patients meeting inclusion criteria, 440 (90.2%) comprised the HOS cohort and 48 (9.8%) comprised SOS. HOS patients were older (59 [52-65] vs 55 [40-62] years, p=0.005), demonstrating a higher median Charleston Comorbidity Index (3 [2-4] vs 3 [2-3], p=0.01) and physiologic MELD at transplant (32 [15-39] vs 13 [10-34], p<0.001). After adjustment for relevant patient and donor factors, decreased odds of 6-month, 12-month, 2-year, and 5-year patient survival were seen for LT recipients with prior hollow-organ surgery (Table 1). Although rates of acute graft rejection were comparable between cohorts (8.0 vs 10.4%, p=0.55), adjusted odds of 2 and 5-year graft survival was significantly lower among patients with prior surgical interventions targeting the gastrointestinal tract.
Conclusion:
LT recipients with a history of hollow-organ gastrointestinal surgery demonstrate inferior long-term outcomes to patients with prior operations targeting the liver, spleen and pancreas. Further research is warranted to discern drivers of delayed morbidity and mortality among this high-risk patient cohort.