Link to the University of Pittsburgh Homepage
Link to the University Library System Homepage Link to the Contact Us Form

Surgical complications in human orthotopic liver transplantation.

Lerut, J and Gordon, RD and Iwatsuki, S and Starzl, TE (1987) Surgical complications in human orthotopic liver transplantation. Acta Chirurgica Belgica, 87 (3). 193 - 204. ISSN 0001-5458

Accepted Version
Available under License : See the attached license file.

Download (3MB) | Preview
[img] Plain Text (licence)
Available under License : See the attached license file.

Download (1kB)


Between March 1, 1980 and December 31, 1984, 393 orthotopic liver transplantations (OLT) were performed in 313 consecutive recipients. Technical complications were responsible for a substantial morbidity (41/393 allograft loss--10.4%) and mortality (26/313 patient loss--8.3%). Failure of the biliary tract reconstruction, mainly expressed as leakage and obstruction, is the most frequent complication of OLT (52/393 grafts--13.2%). Biliary tract complication (BTC) was directly responsible for 5 deaths (9.6%). Reliance upon standardized methods of direct duct-to duct repair with T-tube (CC-T) and Roux-Y choledocho-jejunostomy (RYCH-J), appropriate postoperative investigation and treatment will reduce morbidity and mortality of BTC. A complicated CC-T will be conversed to a RYCH-J; a complicated RYCH-J needs surgical correction. Hepatic artery thrombosis (HAT) has become the "Achilles heel" of OLT. HAT is expressed by three different patterns: fulminant hepatic necrosis, delayed bile leakage and relapsing bacteremia. Diagnosed in 27 grafts (6.8%), HAT was responsible for 16 deaths (16/25 pat: 64%). The only chance to rescue patients presenting HAT is an early diagnosis and prompt retransplantation before occurrence of septic complications. Aneurysm of the hepatic arterial supply (4/393 grafts--1%) also needs aggressive surgery because of the high rate of fatal rupture (3/4 pat--75%). The incidence of thrombosis of the reconstructed portal vein (PVT) was only 2.2% (7 pat.), three inferior vena caval thromboses (0.9%) (CVT) were diagnosed after OLT. Four of the 7 patients whose portal veins clotted are alive. Three have their original graft. One patient, presenting both PVT and CVT, was rescued by prompt retransplantation. PVT was responsible for 3 patient (3/7 pat--42.8%) and 4 graft losses (4/7 pat--57%). The rate of graft (3/3) and patient loss (2/3) was even higher after CVT.


Social Networking:
Share |


Item Type: Article
Status: Published
CreatorsEmailPitt UsernameORCID
Lerut, J
Gordon, RD
Iwatsuki, S
Starzl, TEtes11@pitt.eduTES11
Centers: Other Centers, Institutes, Offices, or Units > Thomas E. Starzl Transplantation Institute
Date: 1 May 1987
Date Type: Publication
Journal or Publication Title: Acta Chirurgica Belgica
Volume: 87
Number: 3
Page Range: 193 - 204
Institution: University of Pittsburgh
Refereed: Yes
ISSN: 0001-5458
Other ID: uls-drl:31735062129394, Starzl CV No. 787
Date Deposited: 08 Apr 2010 17:13
Last Modified: 02 Feb 2019 13:56


Monthly Views for the past 3 years

Plum Analytics

Actions (login required)

View Item View Item