Liver transplant surgery is really a vital and life-saving procedure, but it addittionally is of a higher rate of postoperative complications. As much as one in four liver transplant patients will go back to the operating room (R-OR) within 48 hours of these initial surgery.
Liver transplant recipients with a body mass index (BMI) greater than 30, or what’s considered obesity, who have been matched with livers from donors with a brief history of heavy alcohol use saw an 80% R-OR rate. Further, researchers discovered that a triad of obesity, heavy alcohol use, and coagulopathy, or perhaps a decreased capability to form blood clots and prevent bleeding, were of a 100% R-OR.
“What this tells us is that when possible, we ought to make an effort to not match a recipient with obesity with a donor who includes a history of alcohol use,” explains Hunter Moore, MD, Ph.D., principal investigator on the analysis and an assistant professor of transplant surgery in the University of Colorado School of Medicine. “If we can not minimize the chance, then we’ll make an effort to really manage the recipient’s coagulopathymanage it more aggressively than should they didn’t have those risk factors.”
Risk connected with go back to OR
The study data was drawn from liver transplant recipients signed up for a Colorado Multi-Institutional Review Board study to prospectively collect blood samples through the initial 24 hours following surgery.
“We noticed a higher rate of go back to the operating room using populations, mostly patients with obesity,” Moore says. “We wished to know if obesity was a genuine risk factor and what additional sort of factors were connected with it, also to see if some of those were modifiable to lessen the chance of needing another operation.”
One of many reasons that liver transplant recipients need a second surgery is having a hematoma, or pool of mostly clotted blood, form round the new liver. “Through the transplant operation the liver is really a little slow and requires a while to awaken, which results in slow coagulopathic bleeding which cases blood to coagulate around it,” Moore explains. “It isn’t very harmful, however when there’s lots of it, it puts strain on the liver and may slow its recovery.”
Moore and his co-researchers analyzed data from 160 liver transplant recipients and discovered that 80% of these with a BMI of 30 or more who received a liver from the donor who drank several servings of alcohol each day were back the OR within 48 hours of these first surgery. Every patient with those two risk factors and the added factor of coagulopathy returned to the OR within 48 hours.
Understanding risk factors
“The problems with time for the OR aren’t really linked to any detriment to survival and function,” Moore says. “But since it happens with one in four liver transplant patients, when you can reduce that number it’s far better for patients’ recovery also it reduces the responsibility on OR staff.”
These research findings allows patients, their caregivers, and surgical teams to arrange for R-OR or to mitigate risk before surgery.
“When I see my pre-evaluation liver transplant patients, should they have a BMI that’s 30 or more I tell them that if they are able to work toward getting their BMI below 30 it could reduce their risks of time for the OR and enhance their outcomes,” Moore says. “Another solution to mitigate risk would be to fix coagulation in the OR aggressively. We are able to pre-emptively transfuse them with an increase of hemostatic blood products if we realize their coagulopathy risk before surgery.”
Further research will study risk factors more connected with donors and donated livers. For instance, Moore has begun studying degrees of transaminase, an enzyme, in donor livers, which might be associated with an increased threat of fluid build-up in the belly following transplant surgery.
“Among our main goals would be to better understand risk factors in order that we are able to anticipate outcomes and better arrange for them after and during surgery,” Moore says.
More info: Hunter B. Moore et al, The vexing triad of obesity, alcohol, and coagulopathy predicts the necessity for multiple operations in liver transplantation, The American Journal of Surgery (2022). DOI: 10.1016/j.amjsurg.2022.02.053
Citation: Obesity, alcohol use, and decreased blood clotting connected with go back to operating room after liver transplant (2022, August 26) retrieved 28 August 2022 from https://medicalxpress.com/news/2022-08-obesity-alcohol-decreased-blood-clotting.html
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