Le tamponnement péri hépatique pour hémorragie peropératoire dans le contexte de la transplantation du foie: expérience acquise dans une série de 2500 greffes hépatiquesLiver Packing during Orthotopic Liver Transplantation: a Single Center Experience

Séance du mercredi 12 juin 2013 (SEANCE COMMUNE AVEC LA SOCIETE PIEMONTAISE)

Résumé

AbstractBackground: liver packing (LP) is an accepted technique to achieve rapid control of hemostasis after liver trauma requiring emergent laparotomy. Little is known about the indications and outcomes of this technique used in the context of massive bleeding during orthotopic liver transplantation (OLT)Aim: to investigate the characteristics and outcomes of patients treated by LP during OLTPatients and methods: recipients of a OLT treated by LP for hemorrhage in the period from 2003 to 2013 were identified from operating theater reports. Clinical charts were retrospectively reviewed to collect demographic data, patients and donor characteristics at transplantation, operatory variables, the indication for LP and postoperative outcomes. Results: LP was performed in 98/1399 (7%) of patients, 27% of whom recipients of a second OLT. Median age, Model for End-Stage Liver Disease score and body mass index was 54 years, 18 and 23.7 kg/m2, respectively. At the moment of packing, median pH, lactate and temperature was 7.24, 4.8 mEq/L and 34.6 °C, respectively. A mean of 7,860 ml of blood and 8,280 ml of plasma was transfused during the operation. LP was invariably effective in achieving hemostasis. Depacking was performed during a second (92%) or third (8%) operation, for a mean open abdomen duration of 3 days. Postoperative patient and graft survival rate was 90% and 84%, respectively. Severe postoperative morbidity (Dindo-Clavien 3 – 4) was observed in 26% of the patients.Conclusions: Despite significant postoperative morbidity, LP is effective in achieving hemostasis during OLT, with acceptable patient and graft survival.Intervenant : D CHERQUI (Paris)