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Masior Ł, Krasnodębski M, Smoter P, Morawski M, Kobryń K, Hołówko W, Figiel W, Krawczyk M, Wróblewski T, Grąt M. Rescue liver transplantation for post-hepatectomy liver failure- single center retrospective analysis. BMC Surg 2024; 24:224. [PMID: 39107752 PMCID: PMC11301979 DOI: 10.1186/s12893-024-02515-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Accepted: 07/29/2024] [Indexed: 08/10/2024] Open
Abstract
INTRODUCTION Liver transplantation (LT) is a well-established method applied for the treatment of various liver diseases, including primary and secondary malignancies, as well as acute liver failure triggered by different mechanisms. In turn, liver failure (PHLF) is the most severe complication observed after liver resection (LR). PHLF is an extremely rare indication for LT. The aim of the present study was to assess the results of LT in patients with PHLF. METHODS Relevant cases were extracted from the prospectively collected database of all LTs performed in our center. All clinical variables, details of the perioperative course of each patient and long-term follow-up data were thoroughly assessed. RESULTS Between January 2000 and August 2023, 2703 LTs were carried out. Among them, six patients underwent LT for PHLF, which accounted for 0.2% of all patients. The median age of the patients was 38 years (range 24-66 years). All patients underwent major liver resection before listing for LT. The 90-day mortality after LT was 66.7% (4 out of 6 patients), and all patients experienced complications in the posttransplant course. One patient required early retransplantation due to primary non-function (PNF). The last two transplanted patients are alive at 7 years and 12 months after LT, respectively. CONCLUSIONS In an unselected population of patients with PHLF, LT is a very morbid procedure associated with high mortality but should be considered the only life-saving option in this group.
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Affiliation(s)
- Łukasz Masior
- Department of General, Transplant and Liver Surgery, Medical University of Warsaw, Banacha Street 1A, Warsaw, 02-097, Poland.
| | - Maciej Krasnodębski
- Department of General, Transplant and Liver Surgery, Medical University of Warsaw, Banacha Street 1A, Warsaw, 02-097, Poland
| | - Piotr Smoter
- Department of General, Transplant and Liver Surgery, Medical University of Warsaw, Banacha Street 1A, Warsaw, 02-097, Poland
| | - Marcin Morawski
- Department of General, Transplant and Liver Surgery, Medical University of Warsaw, Banacha Street 1A, Warsaw, 02-097, Poland
| | - Konrad Kobryń
- Department of General, Transplant and Liver Surgery, Medical University of Warsaw, Banacha Street 1A, Warsaw, 02-097, Poland
| | - Wacław Hołówko
- Department of General, Transplant and Liver Surgery, Medical University of Warsaw, Banacha Street 1A, Warsaw, 02-097, Poland
| | - Wojciech Figiel
- Department of General, Transplant and Liver Surgery, Medical University of Warsaw, Banacha Street 1A, Warsaw, 02-097, Poland
| | - Marek Krawczyk
- Department of General, Transplant and Liver Surgery, Medical University of Warsaw, Banacha Street 1A, Warsaw, 02-097, Poland
| | - Tadeusz Wróblewski
- Department of General, Transplant and Liver Surgery, Medical University of Warsaw, Banacha Street 1A, Warsaw, 02-097, Poland
| | - Michał Grąt
- Department of General, Transplant and Liver Surgery, Medical University of Warsaw, Banacha Street 1A, Warsaw, 02-097, Poland
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Hołówko W, Serednicki W, Bartkowiak M, Wysocki M, Domurat M, Mielko J, Pierściński S, Hogendorf P, Masior Ł, Kalinowski P, Wierdak M, Frączek M, Tarasik A, Wróblewski T, Budzyński A, Pędziwiatr M, Grąt M. Early adoption of laparoscopic liver surgery in Poland: a national retrospective cohort study. Int J Surg 2024; 110:361-371. [PMID: 37816169 PMCID: PMC10793755 DOI: 10.1097/js9.0000000000000840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 09/29/2023] [Indexed: 10/12/2023]
Abstract
BACKGROUND The need for safe and efficient dissemination of minimally invasive approach in liver surgery is among the current challenges for hepatobiliary surgeons. After the stage of innovators and pioneers, the following countries should adopt a laparoscopic approach. The aim of this study was to assess the national experience and trend in implementing laparoscopic liver resection (LLR) in Poland. MATERIALS AND METHODS A national registry of LLR performed in Poland was established in June 2020. All LLR cases performed before were included retrospectively, followed by prospectively collected new cases. Baseline characteristics, preoperative and intraoperative data, short-term results and long-term follow-up were recorded. RESULTS Since 2010 up to the end of 2022 there were 718 LLRs performed in Poland. The national rate of laparoscopic approach has gradually increased since 2017 ( P <0.001), reaching the rate of 11.7% in 2022. There were 443 (61.7%), 107 (14.9%), and 168 (23.4%) LLRs performed in accordance to increasing grades of difficulty. The move towards more demanding cases had an increasing trend over the years ( P <0.001). Total intraoperative adverse event and postoperative severe complications rates were estimated for 13.5% ( n =97) and 6.7% ( n =48), respectively. 30-day reoperation, readmission and postoperative mortality rates were 3.6% ( n =26), 2.8% ( n =20), and 0.8% ( n =6), respectively. While the R0 resection margin was assessed in 643 (89.6%) cases, the total textbook outcomes (TO) were achieved in 525 (74.5%) cases. Overcoming the learning curve of 60 LLRs, resulted in an increasing TO rate from 72.3 to 80.6% ( P =0.024). CONCLUSIONS It is the first national analysis of a laparoscopic approach in liver surgery in Poland. An increasing trend of minimizing invasiveness in liver resection has been observed. Responsible selection of cases in accordance with difficulty may provide results within global benchmark values and textbook outcomes already during the learning curve.
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Affiliation(s)
| | - Wojciech Serednicki
- 2nd Department of General Surgery, Jagiellonian University Medical College, Cracow
| | | | - Michał Wysocki
- Department of General Surgery and Surgical Oncology, Ludwik Rydygier Memorial Hospital
| | - Marian Domurat
- Department of Oncological Surgery, Regional Oncological Center, Białystok, Poland
| | - Jerzy Mielko
- Department of Surgical Oncology, Medical University of Lublin, Lublin
| | - Stanisław Pierściński
- Department of General and Endocrine Surgery, Nicolaus Copernicus University Collegium Medicum, Bydgoszcz
| | - Piotr Hogendorf
- Department of General and Transplant Surgery, Medical University of Łódź, Barlicki Teaching Hospital, Łódź
| | - Łukasz Masior
- Department of General Transplant and Liver Surgery
- Department of General, Vascular and Oncological Surgery, Medical University of Warsaw, Warsaw
| | | | - Mateusz Wierdak
- 2nd Department of General Surgery, Jagiellonian University Medical College, Cracow
| | - Mariusz Frączek
- Department of General, Vascular and Oncological Surgery, Medical University of Warsaw, Warsaw
| | - Aleksander Tarasik
- Department of Oncological Surgery, Regional Oncological Center, Białystok, Poland
| | | | - Andrzej Budzyński
- Department of General Surgery and Surgical Oncology, Ludwik Rydygier Memorial Hospital
| | - Michał Pędziwiatr
- 2nd Department of General Surgery, Jagiellonian University Medical College, Cracow
| | - Michał Grąt
- Department of General Transplant and Liver Surgery
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Mavrothalassitis O, Marcus SG, Roll GR, Tallarico RT, Bokoch MP. Pulmonary Injury Causing a Massive Air Leak During Liver Transplantation: A Case Report and Discussion of Decision-Making. A A Pract 2023; 17:e01694. [PMID: 37335882 DOI: 10.1213/xaa.0000000000001694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/21/2023]
Abstract
Pulmonary injury can occur during liver transplantation in patients with prior liver surgery, infection, or hepatocellular carcinoma treatments. Compromise of gas exchange during liver transplantation mandates rapid, multidisciplinary decision-making. We present a case of lung parenchymal injury causing a massive air leak during the dissection phase of a liver transplant. An endobronchial blocker was used for emergency lung isolation. Since oxygenation and pH were stable, we proceeded with liver transplantation to minimize graft ischemic time, followed by thoracic repair. The postoperative course was notable for adequate early liver function and discharge after prolonged postoperative ventilation and tube thoracostomy drainage.
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Affiliation(s)
| | | | - Garrett R Roll
- Division of Transplantation, Department of Surgery, University of California San Francisco, San Francisco, California
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Grąt M, Morawski M, Krasnodębski M, Borkowski J, Krawczyk P, Grąt K, Stypułkowski J, Maczkowski B, Figiel W, Lewandowski Z, Kobryń K, Patkowski W, Krawczyk M, Wróblewski T, Otto W, Paluszkiewicz R, Zieniewicz K. Incisional Surgical Site Infections After Mass and Layered Closure of Upper Abdominal Transverse Incisions: First Results of a Randomized Controlled Trial. Ann Surg 2021; 274:690-697. [PMID: 34353985 DOI: 10.1097/sla.0000000000005128] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To compare the early results of mass and layered closure of upper abdominal transverse incisions. SUMMARY OF BACKGROUND DATA Contrary to midline incisions, data on closure of transverse abdominal incisions are lacking. METHODS This is the first analysis of a randomized controlled trial primarily designed to compare mass with layered closure of transverse incisions with respect to incisional hernias. Patients undergoing laparotomy through upper abdominal transverse incisions were randomized to either mass or layered closure with continuous sutures. Incisional surgical site infection (incisional-SSI) was the primary end-point. Secondary end-points comprised suture-to-wound length ratio (SWLR), closure duration, and fascial dehiscence (clinicatrials.gov NCT03561727). RESULTS A total of 268 patients were randomized to either mass (n=134) or layered (n=134) closure. Incisional-SSIs occurred in 24 (17.9%) and 8 (6.0%) patients after mass and layered closure, respectively (P =0.004), with crude odds ratio (OR) of 0.29 [95% confidence interval (95% CI) 0.13-0.67; P =0.004]. Layered technique was independently associated with fewer incisional-SSIs (OR: 0.29; 95% CI 0.12-0.69; P =0.005). The number needed to treat, absolute, and relative risk reduction for layered technique in reducing incisional-SSIs were 8.4 patients, 11.9%, and 66.5%, respectively. Dehiscence occurred in one (0.8%) patient after layered closure and in two (1.5%) patients after mass closure (P >0.999). Median SWLR were 8.1 and 5.6 (P <0.001) with median closure times of 27.5 and 25.0 minutes (P =0.044) for layered and mass closures, respectively. CONCLUSIONS Layered closure of upper abdominal transverse incisions should be preferred due to lower risk of incisional-SSIs and higher SWLR, despite clinically irrelevant longer duration.
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Affiliation(s)
- Michał Grąt
- Department of General, Transplant and Liver Surgery, Warsaw, Poland
| | - Marcin Morawski
- Department of General, Transplant and Liver Surgery, Warsaw, Poland
| | | | - Jan Borkowski
- Department of General, Transplant and Liver Surgery, Warsaw, Poland
| | - Piotr Krawczyk
- Department of General, Transplant and Liver Surgery, Warsaw, Poland
| | - Karolina Grąt
- Second Department of Clinical Radiology, Warsaw, Poland
| | - Jan Stypułkowski
- Department of General, Transplant and Liver Surgery, Warsaw, Poland
| | | | - Wojciech Figiel
- Department of General, Transplant and Liver Surgery, Warsaw, Poland
| | - Zbigniew Lewandowski
- Department of Epidemiology and Biostatistics, Medical University of Warsaw, Warsaw, Poland
| | - Konrad Kobryń
- Department of General, Transplant and Liver Surgery, Warsaw, Poland
| | | | - Marek Krawczyk
- Department of General, Transplant and Liver Surgery, Warsaw, Poland
| | | | - Włodzimierz Otto
- Department of General, Transplant and Liver Surgery, Warsaw, Poland
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Li K, Jiang F, Aizpuru M, Larson EL, Xie X, Zhou R, Xiang B. Successful management and technical aspects of major liver resection in children: A retrospective cohort study. Medicine (Baltimore) 2021; 100:e24420. [PMID: 33578534 PMCID: PMC7886405 DOI: 10.1097/md.0000000000024420] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Accepted: 01/03/2021] [Indexed: 02/05/2023] Open
Abstract
Optimal treatment of patients with various types of liver tumors or certain liver diseases frequently demands major liver resection, which remains a clinical challenge especially in children.Eighty seven consecutive pediatric liver resections including 51 (59%) major resections (resection of 3 or more hepatic segments) and 36 (41%) minor resections (resection of 1 or 2 segments) were analyzed. All patients were treated between January 2010 and March 2018. Perioperative outcomes were compared between major and minor hepatic resections.The male to female ratio was 1.72:1. The median age at operation was 20 months (range, 0.33-150 months). There was no significant difference in demographics including age, weight, ASA class, and underlying pathology. The surgical management included functional assessment of the future liver remnant, critical perioperative management, enhanced understanding of hepatic segmental anatomy, and bleeding control, as well as refined surgical techniques. The median estimated blood loss was 40 ml in the minor liver resection group, and 90 ml in major liver resection group (P < .001). Children undergoing major liver resection had a significantly longer median operative time (80 vs 140 minutes), anesthesia time (140 vs 205 minutes), as well as higher median intraoperative total fluid input (255 vs 450 ml) (P < .001 for all). Fourteen (16.1%) patients had postoperative complications. By Clavien-Dindo classification, there were 8 grade I, 4 grade II, and 2 grade III-a complications. There were no significant differences in complication rates between groups (P = .902). Time to clear liquid diet (P = .381) and general diet (P = .473) was not significantly different. There was no difference in hospital length of stay (7 vs 7 days, P = .450). There were no 90-day readmissions or mortalities.Major liver resection in children is not associated with an increased incidence of postoperative complications or prolonged postoperative hospital stay compared to minor liver resection. Techniques employed in this study offered good perioperative outcomes for children undergoing major liver resections.
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Affiliation(s)
- Kewei Li
- Department of Pediatric Surgery, West China Hospital of Sichuan University
| | - Fanwen Jiang
- West China School of Medicine of Sichuan University, Chengdu, China
| | | | | | - Xiaolong Xie
- Department of Pediatric Surgery, West China Hospital of Sichuan University
| | - Rongxing Zhou
- Department of Biliary Surgery, West China Hospital of Sichuan University, Chengdu, China
| | - Bo Xiang
- Department of Pediatric Surgery, West China Hospital of Sichuan University
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Chatterjee S, LeMaire SA, Green SY, Price MD, Amarasekara HS, Zhang Q, Pirko CJ, Preventza O, de la Cruz KI, Todd SR, Coselli JS. Is incidental splenectomy during thoracoabdominal aortic aneurysm repair associated with reduced survival? J Thorac Cardiovasc Surg 2020; 160:641-652.e2. [DOI: 10.1016/j.jtcvs.2019.07.133] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Revised: 06/27/2019] [Accepted: 07/03/2019] [Indexed: 01/06/2023]
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Postoperative day one serum alanine aminotransferase does not predict patient morbidity and mortality after elective liver resection in non-cirrhotic patients. Hepatobiliary Pancreat Dis Int 2016; 15:655-659. [PMID: 27919856 DOI: 10.1016/s1499-3872(16)60090-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Serum aminotransferases have been used as surrogate markers for liver ischemia-reperfusion injury that follows liver surgery. Some studies have suggested that rises in serum alanine aminotransferase (ALT) correlate with patient outcome after liver resection. We assessed whether postoperative day 1 (POD 1) ALT could be used to predict patient morbidity and mortality following liver resection. We reviewed our prospectively held database and included consecutive adult patients undergoing elective liver resection in our institution between January 2013 and December 2014. Primary outcome assessed was correlation of POD 1 ALT with patient's morbidity and mortality. We also assessed whether concurrent radiofrequency ablation, neoadjuvant chemotherapy and use of the Pringle maneuver significantly affected the level of POD 1 ALT. A total of 110 liver resections were included in the study. The overall in-hospital patient morbidity and mortality were 31.8% and 0.9%, respectively. The median level of POD 1 ALT was 275 IU/L. No correlation was found between POD 1 serum ALT levels and patient morbidity after elective liver resection, whilst correlation with mortality was not possible because of the low number of mortalities. Patients undergoing concurrent radiofrequency ablation were noted to have an increased level of POD 1 serum ALT but not those given neoadjuvant chemotherapy and those in whom the Pringle maneuver was used. Our study demonstrates POD 1 serum ALT does not correlate with patient morbidity after elective liver resection.
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Risk of Intraoperative Injury of Nearby Structures: National Trend, Distribution, and Burden. J Am Coll Surg 2016; 222:624-31. [PMID: 26916128 DOI: 10.1016/j.jamcollsurg.2015.12.040] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Accepted: 12/17/2015] [Indexed: 11/20/2022]
Abstract
BACKGROUND Accidental injury of a nearby structure during surgical operations carries a risk of serious morbidity and mortality. Furthermore, it represents a medico-legal liability. We aimed to examine the national distribution, cost, and trend of accidental intraoperative injuries. STUDY DESIGN We performed a cross-sectional study using the Nationwide Inpatient Sample database. The study population consisted of patients who encountered intraoperative injuries between 2003 and 2010. Controls were randomly selected from patients who underwent similar procedures during the same period. Cost was adjusted for inflation rate to reflect 2015 dollar values. RESULTS A total of 61,667 cases with intraoperative injuries and 430,424 controls were included. Intraoperative injuries were most common in procedures that involved the digestive system (38.0%), female reproductive organs (21.4%), and musculoskeletal system (12.2%). There was a significant increase in those injuries from 161.3 cases/100,000 procedures in 2003 to 254.9 cases/100,000 procedures in 2010 (p < 0.001). Female sex, pediatric and older populations, overweight, trauma and teaching hospital were all independent risk factors of injuries in the multivariate model (p < 0.05 for all). Intraoperative injuries were associated with a higher risk of concomitant complications (odds ratio [OR] 2.44, 95% CI 2.36, 2.54, p < 0.001) and hospital mortality risk (OR 2.33, 95% CI [2.15, 2.51], p < 0.001). Nationally, it is estimated that injuries of nearby structures resulted in an annual average of 84,708.7 days of excess hospital admission days and $426.33 million excess cost. CONCLUSIONS Certain demographic and clinical factors influence the risk of intraoperative injury of nearby structures. The prevalence of intraoperative injuries is increasing at the national level, and these injuries are associated with increased mortality and pose substantial clinical and financial burdens.
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Krawczyk M, Grąt M, Grąt K, Wronka K, Krasnodębski M, Stypułkowski J, Masior Ł, Hołówko W, Ligocka J, Nyckowski P, Wróblewski T, Paluszkiewicz R, Patkowski W, Zieniewicz K, Pączek L, Milkiewicz P, Ołdakowska-Jedynak U, Najnigier B, Dudek K, Remiszewski P, Grzelak I, Kornasiewicz O, Kotulski M, Smoter P, Grodzicki M, Korba M, Kalinowski P, Skalski M, Zając K, Stankiewicz R, Przybysz M, Cieślak B, Nazarewski Ł, Nowosad M, Kobryń K, Wasilewicz M, Raszeja-Wyszomirska J, Piwowarska J, Giercuszkiewicz D, Sańko-Resmer J, Rejowski S, Szydłowska-Jakimiuk M, Górnicka B, Wróblewska-Ziarkiewicz B, Mazurkiewicz M, Niewiński G, Pawlak J, Pacho R. Evolution Of The Results Of 1500 Liver Transplantations Performed In The Department Of General, Transplant And Liver Surgery Medical University Of Warsaw. POLISH JOURNAL OF SURGERY 2015; 87:221-230. [PMID: 26172161 DOI: 10.1515/pjs-2015-0046] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2015] [Indexed: 09/25/2023]
Abstract
UNLABELLED Liver transplantation is a well-established treatment of patients with end-stage liver disease and selected liver tumors. Remarkable progress has been made over the last years concerning nearly all of its aspects. The aim of this study was to evaluate the evolution of long-term outcomes after liver transplantations performed in the Department of General, Transplant and Liver Surgery (Medical University of Warsaw). MATERIAL AND METHODS Data of 1500 liver transplantations performed between 1989 and 2014 were retrospectively analyzed. Transplantations were divided into 3 groups: group 1 including first 500 operations, group 2 including subsequent 500, and group 3 comprising the most recent 500. Five year overall and graft survival were set as outcome measures. RESULTS Increased number of transplantations performed at the site was associated with increased age of the recipients (p<0.001) and donors (p<0.001), increased rate of male recipients (p<0.001), and increased rate of piggyback operations (p<0.001), and decreased MELD (p<0.001), as well as decreased blood (p=0.006) and plasma (p<0.001) transfusions. Overall survival was 71.6% at 5 years in group 1, 74.5% at 5 years in group 2, and 85% at 2.9 years in group 3 (p=0.008). Improvement of overall survival was particularly observed for primary transplantations (p=0.004). Increased graft survival rates did not reach the level of significance (p=0.136). CONCLUSIONS Long-term outcomes after liver transplantations performed in the Department of General, Transplant and Liver Surgery are comparable to those achieved in the largest transplant centers worldwide and are continuously improving despite increasing recipient age and wider utilization of organs procured from older donors.
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Grąt M, Hołówko W, Lewandowski Z, Kornasiewicz O, Barski K, Skalski M, Zieniewicz K, Krawczyk M. Early post-operative prediction of morbidity and mortality after a major liver resection for colorectal metastases. HPB (Oxford) 2013; 15:352-8. [PMID: 23557408 PMCID: PMC3633036 DOI: 10.1111/j.1477-2574.2012.00596.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2012] [Accepted: 09/10/2012] [Indexed: 12/12/2022]
Abstract
BACKGROUND An early prediction of poor outcomes is essential in the management of patients after a liver resection. The aim of this study was to evaluate the role of selected biochemical parameters on post-operative day 1 (POD 1) in the prediction of morbidity and mortality after a liver resection for colorectal metastases. METHOD This retrospective study was based on 236 major liver resections for colorectal metastases performed between 2006 and 2011. Results of biochemical tests of blood samples obtained on POD 1 were assessed as predictors of primary outcome measures (hepatic and overall morbidity, 90-day mortality) using multiple regression and receiver-operating characteristics (ROC). RESULTS Hepatic morbidity, overall morbidity and 90-day mortality rates were 18.6%, 28.0% and 4.7%, respectively. On the basis of multiple regression analysis and comparisons of the prediction models, serum bilirubin was selected for the prediction of hepatic (>2.05 mg/dl, sensitivity 69.2%, specificity 71.2%) and overall (>2.05 mg/dl, sensitivity 61.1% and specificity 71.2%) morbidity, and aspartate aminotransferase (AST) was selected for the prediction of 90-day mortality (>798 U/l, sensitivity 62.5% and specificity 90.4%). DISCUSSION Biochemical analyses of blood on POD1 enables stratification of patients into low- and high-risk groups for negative outcomes, with serum bilirubin associated with overall and hepatic morbidity and AST associated with mortality.
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Affiliation(s)
- Michał Grąt
- Department of General, Transplant and Liver Surgery, Medical University of WarsawWarsaw, Poland
| | - Wacław Hołówko
- Department of General, Transplant and Liver Surgery, Medical University of WarsawWarsaw, Poland
| | | | - Oskar Kornasiewicz
- Department of General, Transplant and Liver Surgery, Medical University of WarsawWarsaw, Poland
| | - Krzysztof Barski
- Department of General, Transplant and Liver Surgery, Medical University of WarsawWarsaw, Poland
| | - Michał Skalski
- Department of General, Transplant and Liver Surgery, Medical University of WarsawWarsaw, Poland
| | - Krzysztof Zieniewicz
- Department of General, Transplant and Liver Surgery, Medical University of WarsawWarsaw, Poland
| | - Marek Krawczyk
- Department of General, Transplant and Liver Surgery, Medical University of WarsawWarsaw, Poland
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