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Lee IK, Chang PH, Yeh CH, Li WF, Yin SM, Lin YC, Tzeng WJ, Chen CL, Lin CC, Wang CC. Risk factors and crucial prognostic indicators of mortality in liver transplant recipients with bloodstream infections: A comprehensives study of 1049 consecutive liver transplants over an 11-year period. JOURNAL OF MICROBIOLOGY, IMMUNOLOGY, AND INFECTION = WEI MIAN YU GAN RAN ZA ZHI 2024:S1684-1182(24)00109-9. [PMID: 38944568 DOI: 10.1016/j.jmii.2024.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 04/22/2024] [Accepted: 06/15/2024] [Indexed: 07/01/2024]
Abstract
BACKGROUND Liver transplantation (LT) is a pivotal treatment for end-stage liver disease. However, bloodstream infections (BSI) in the post-operative period present a significant threat to patient survival. This study aims to identify risk factors for post-LT BSI and crucial prognostic indicators for mortality among affected patients. METHODS We conducted a retrospective study of adults diagnosed with end-stage liver disease who underwent their initial LT between 2010 and 2021. Those who developed BSI post-LT during the same hospital admission were classified into the BSI group. RESULTS In this cohort of 1049 patients, 89 (8.4%) developed BSI post-LT, while 960 (91.5%) did not contract any infection. Among the BSI cases, 17 (19.1%) patients died. The average time to BSI onset was 48 days, with 46% occurring within the first month post-LT. Of the 123 isolated microorganisms, 97 (78.8%) were gram-negative bacteria. BSI patients had significantly longer stays in the intensive care unit and hospital compared to non-infected patients. The 90-day and in-hospital mortality rates for recipients with BSI were significantly higher than those without infections. Multivariate analysis indicated heightened BSI risk in patients with blood loss >3000 mL during LT (odds ratio [OR] 2.128), re-operation within 30 days (OR 2.341), post-LT bile leakage (OR 3.536), and graft rejection (OR 2.194). Additionally, chronic kidney disease (OR 6.288), each 1000 mL increase in intraoperative blood loss (OR 1.147) significantly raised mortality risk in BSI patients, whereas each 0.1 mg/dL increase in albumin levels correlated with a lower risk of death from BSI (OR 0.810). CONCLUSIONS This study underscores the need for careful monitoring and management in the post-LT period, especially for patients at higher risk of BSI. It also suggests that serum albumin levels could serve as a valuable prognostic indicator for outcomes in LT recipients experiencing BSI.
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Affiliation(s)
- Ing-Kit Lee
- Division of Infectious Diseases, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan; Chang Gang University, College of Medicine, Taoyuan, Taiwan
| | - Po-Hsun Chang
- Department of Pharmacy, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Cheng-Hsi Yeh
- Department of Surgery, Liver Transplantation Program, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Wei-Feng Li
- Department of Surgery, Liver Transplantation Program, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Shih-Min Yin
- Department of Surgery, Liver Transplantation Program, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Yu-Cheng Lin
- Department of Surgery, Liver Transplantation Program, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Wei-Juo Tzeng
- Department of Surgery, Liver Transplantation Program, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Chao-Long Chen
- Department of Surgery, Liver Transplantation Program, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Chih-Che Lin
- Department of Surgery, Liver Transplantation Program, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Chih-Chi Wang
- Chang Gang University, College of Medicine, Taoyuan, Taiwan; Department of Surgery, Liver Transplantation Program, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan.
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2
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Nejatollahi SMR, Nazari M, Mostafavi K, Ghorbani F. Reoperation etiologies in the initial hospital stay after liver transplantation: a single-center study from Iran. KOREAN JOURNAL OF TRANSPLANTATION 2023; 37:103-108. [PMID: 37435148 PMCID: PMC10332282 DOI: 10.4285/kjt.23.0026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 06/14/2023] [Accepted: 06/15/2023] [Indexed: 07/13/2023] Open
Abstract
Background Liver transplantation (LT) is widely recognized as a life-saving therapy for patients with end-stage liver disease. However, due to certain posttransplant complications, reoperations or endovascular interventions may be necessary to improve patient outcomes. This study was conducted to examine reasons for reoperation during the initial hospital stay following LT and to identify its predictive factors. Methods We evaluated the incidence and etiology of reoperation in 133 patients who underwent LT from brain-dead donors over a 9-year period based on our experiences. Results A total of 52 reoperations were performed for 29 patients, with 17 patients requiring one reoperation, seven requiring two, three requiring three, one requiring four, and one requiring eight. Four patients underwent liver retransplantation. The most common cause of reoperation was intra-abdominal bleeding. Hypofibrinogenemia was identified as the sole predisposing factor for bleeding. Frequencies of comorbidities such as diabetes mellitus and hypertension did not differ significantly between groups. Among patients who underwent reoperation due to bleeding, the mean plasma fibrinogen level was 180.33±68.21 mg/dL, while among reoperated patients without bleeding, it was 240.62±105.14 mg/dL (P=0.045; standard mean difference, 0.61; 95% confidence interval, 0.19-1.03). The initial hospital stay was significantly longer for the reoperated group (47.5±15.5 days) than for the non-reoperated group (22.5±5.5 days). Conclusions Meticulous pretransplant assessment and postoperative care are essential for the early identification of predisposing factors and posttransplant complications. In order to enhance graft and patient outcomes, any complications should be addressed without hesitation, and appropriate intervention or surgery should not be delayed.
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Affiliation(s)
- Seyed Mohammad Reza Nejatollahi
- Hepato-Pancreato-Biliary and Transplant Surgery, Masih Daneshvari Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Maryam Nazari
- Hepato-Pancreato-Biliary and Transplant Surgery, Masih Daneshvari Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Keihan Mostafavi
- Lung Transplantation Research Center, National Research Institute of Tuberculosis and Lung Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Fariba Ghorbani
- Tracheal Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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3
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Amara D, Parekh J, Sudan D, Elias N, Foley DP, Conzen K, Grieco A, Braun HJ, Greenstein S, Byrd C, Ko C, Hirose R. Surgical complications after living and deceased donor liver transplant: The NSQIP transplant experience. Clin Transplant 2022; 36:e14610. [PMID: 35143698 DOI: 10.1111/ctr.14610] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Revised: 01/14/2022] [Accepted: 01/31/2022] [Indexed: 12/01/2022]
Abstract
This study used the prospective National Surgical Quality Improvement Program (NSQIP) Transplant pilot database to analyze surgical complications after liver transplantation (LT) in LT recipients from 2017-2019. The primary outcome was surgical complication requiring intervention (Clavien-Dindo grade II or greater) within 90 days of transplant. Of the 1684 deceased donor and 109 living donor LT cases included from 29 centers, 38% of deceased donor liver recipients and 47% of living donor liver recipients experienced a complication. The most common complications included biliary complications (19% DDLT; 31% LDLT), hemorrhage requiring reoperation (14% DDLT; 9% LDLT) and vascular complications (6% DDLT; 9% LDLT). Management of biliary leaks (35.3% ERCP, 38.0% percutaneous drainage, 26.3% reoperation) and vascular complications (36.2% angioplasty/stenting, 31.2% medication, 29.8% reoperation) was variable. Biliary (aHR 5.14, 95% CI 2.69-9.8, p<0.001), hemorrhage (aHR 2.54, 95% CI 1.13-5.7, p = 0.024) and vascular (aHR 2.88, 95% CI 0.85-9.7, p = 0.089) complication status at 30-days post-transplant were associated with lower 1-year patient survival. We conclude that biliary, hemorrhagic and vascular complications continue to be significant sources of morbidity and mortality for LT recipients. Understanding the different risk factors for complications between deceased and living donor liver recipients and standardizing complication management represent avenues for continued improvement. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Dominic Amara
- School of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Justin Parekh
- Department of Surgery, University of California San Diego, San Diego, CA, USA
| | - Debra Sudan
- Department of Surgery, Duke University, Durham, NC, USA
| | - Nahel Elias
- Department of Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - David P Foley
- Department of Surgery, University of Wisconsin, Madison, WI, USA
| | - Kendra Conzen
- Department of Surgery, University of Colorado, Aurora, CO, USA
| | | | - Hillary J Braun
- Department of Surgery, University of California San Francisco, San Francisco, CA, USA
| | | | | | - Clifford Ko
- American College of Surgeons, Chicago, IL, USA.,Department of Surgery, University of California Los Angeles, Los Angeles, CA, USA.,The Healthcare Improvement Studies Institute (THIS Institute), University of Cambridge, Cambridge, UK
| | - Ryutaro Hirose
- Department of Surgery, University of California San Francisco, San Francisco, CA, USA
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4
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Pozo-Laderas J, Guler I, Rodríguez-Perálvarez M, Robles J, Mula A, López-Cillero P, de la Fuente C. Early postoperative mortality in liver transplant recipients involving indications other than hepatocellular carcinoma. A retrospective cohort study. Med Intensiva 2021. [DOI: 10.1016/j.medin.2020.02.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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5
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Pozo-Laderas JC, Guler I, Rodríguez-Perálvarez M, Robles JC, Mula A, López-Cillero P, de la Fuente C. Early postoperative mortality in liver transplant recipients involving indications other than hepatocellular carcinoma. A retrospective cohort study. Med Intensiva 2021; 45:395-410. [PMID: 34563340 DOI: 10.1016/j.medine.2020.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Accepted: 02/11/2020] [Indexed: 11/28/2022]
Abstract
AIMS To analyze the perioperative differences in a consecutive cohort of liver transplant recipients (LTRs) classified according to the indication of transplantation, and assess their impact upon early mortality 90 days after transplantation. DESIGN A retrospective cohort study was carried out. SCOPE A single university hospital. PATIENTS A total of 892 consecutive adult LTRs were included from January 1995 to December 2017. Recipients with acute liver failure, retransplantation or with grafts from non-brain death donors were excluded. Two cohorts were analyzed according to transplant indication: hepatocellular carcinoma (HCC-LTR) versus non-carcinoma (non-HCC-LTR). MAIN VARIABLES OF INTEREST Recipient early mortality was the primary endpoint. The pretransplant recipient and donor characteristics, surgical time data and postoperative complications were analyzed as independent predictors. RESULTS The crude early postoperative mortality rate related to transplant indication was 13.3% in non-HCC-LTR and 6.6% in HCC-LTR (non-adjusted HR=2.12, 95%CI=1.25-3.60; p=0.005). Comparison of the perioperative features between the cohorts revealed multiple differences. Multivariate analysis showed postoperative shock (HR=2.02, 95%CI=1.26-3.24; p=0.003), early graft vascular complications (HR=4.01, 95%CI=2.45-6.56; p<0.001) and multiorgan dysfunction syndrome (HR=18.09, 95%CI=10.70-30.58; p<0.001) to be independent predictors of mortality. There were no differences in early mortality related to transplant indication (adjusted HR=1.60, 95%CI=0.93-2.76; p=0.086). CONCLUSIONS The crude early postoperative mortality rate in non-HCC-LTR was higher than in HCC-LTR, due to a greater incidence of postoperative complications with an impact upon mortality (shock at admission to intensive care and the development of multiorgan dysfunction syndrome).
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Affiliation(s)
- J C Pozo-Laderas
- Intensive Care Medicine, Reina Sofia University Hospital and Maimonides Biomedical Research Institute (IMIBIC), Cordoba, Spain.
| | - I Guler
- Methodology and Biostatistics, IMIBIC, Cordoba, Spain
| | | | - J C Robles
- Intensive Care Medicine, Reina Sofia University Hospital and Maimonides Biomedical Research Institute (IMIBIC), Cordoba, Spain
| | - A Mula
- Intensive Care Medicine, Reina Sofia University Hospital and Maimonides Biomedical Research Institute (IMIBIC), Cordoba, Spain
| | - P López-Cillero
- Surgery and Liver Transplantation, Reina Sofia University Hospital and IMIBIC, Cordoba, Spain
| | - C de la Fuente
- Intensive Care Medicine, Reina Sofia University Hospital and Maimonides Biomedical Research Institute (IMIBIC), Cordoba, Spain
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Watanabe ALC, Feijó MS, Menezes VPLD, Galdino-Vasconcelos MR, Caballero JLS, Ferreira G, Jorge F, Trevizoli N, Diaz LG, Campos PBD, Cajá G, Ullmann R, Figueira AV, Morato T, Moraes A, Pereira JRB, Perosa M. 500 Consecutive Liver Transplants: The Outcomes of a New Transplantation Program in the Middle West of Brazil. Transplant Proc 2021; 53:73-82. [PMID: 32981691 DOI: 10.1016/j.transproceed.2020.06.044] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 06/04/2020] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Liver transplantation is the standard treatment for end-stage liver disease. Brazil holds the third highest number of liver transplants performed per year, but center maldistribution results in high discrepancies in accessing this treatment. In 2012, an interstate partnership successfully implemented a new liver transplantation program in the middle west of Brazil. Here, we report the results of the first 500 liver transplants performed in this new program and discuss the impacts of a new transplant center in regional transplantation dynamics. METHODS We reviewed data from the first 500 consecutive deceased donor liver transplants performed in the new program during an 8-year period. We analyzed data on patients' clinical and demographic profiles, postoperative outcomes, and graft and recipient survival rates. Univariate survival analysis was conducted using log-rank tests to compare the groups. RESULTS Almost half (48%) of the procured organs and 40% of the recipients transplanted in our center were from outside our state. Recipient 30-day mortality was 9%. Overall recipient survival at 1 year and 5 years was 85% and 80%, respectively. Mortality was significantly associated with higher Model for End-Stage Liver Disease (P < .001) but not with the presence of hepatocellular carcinoma (P = .795). DISCUSSION The new transplantation program treated patients from different regions of Brazil and became the reference center in liver transplantation for the middle west region. Despite the recent implementation, our outcomes are comparable to experienced centers around the world. This model can inspire the creation of new transplantation programs aiming to democratize access to liver transplantation nationwide.
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Affiliation(s)
- André Luís Conde Watanabe
- Faculty of Medicine, University of Brasilia, Campus Universitário Darcy Ribeiro, Brasilia, Federal District, Brazil; Department of Liver Transplantation, Instituto de Cardiologia do Distrito Federal (ICDF), Setor HFA Hospital das Forças Armadas, Brasilia, Federal District, Brazil; Department of Liver Transplantation, Hospital Brasilia, Setor de Habitações Individuais Sul, Brasilia, Federal District, Brazil
| | - Mateus Silva Feijó
- Faculty of Medicine, University of Brasilia, Campus Universitário Darcy Ribeiro, Brasilia, Federal District, Brazil.
| | | | | | - Jorge Luis Salinas Caballero
- Faculty of Medicine, University of Brasilia, Campus Universitário Darcy Ribeiro, Brasilia, Federal District, Brazil
| | - Gustavo Ferreira
- Department of Liver Transplantation, Instituto de Cardiologia do Distrito Federal (ICDF), Setor HFA Hospital das Forças Armadas, Brasilia, Federal District, Brazil
| | - Fernando Jorge
- Department of Liver Transplantation, Instituto de Cardiologia do Distrito Federal (ICDF), Setor HFA Hospital das Forças Armadas, Brasilia, Federal District, Brazil; Department of Liver Transplantation, Hospital Brasilia, Setor de Habitações Individuais Sul, Brasilia, Federal District, Brazil
| | - Natália Trevizoli
- Department of Liver Transplantation, Instituto de Cardiologia do Distrito Federal (ICDF), Setor HFA Hospital das Forças Armadas, Brasilia, Federal District, Brazil; Department of Liver Transplantation, Hospital Brasilia, Setor de Habitações Individuais Sul, Brasilia, Federal District, Brazil
| | - Luiz Gustavo Diaz
- Department of Liver Transplantation, Instituto de Cardiologia do Distrito Federal (ICDF), Setor HFA Hospital das Forças Armadas, Brasilia, Federal District, Brazil; Department of Liver Transplantation, Hospital Brasilia, Setor de Habitações Individuais Sul, Brasilia, Federal District, Brazil
| | - Priscila Brizolla de Campos
- Department of Liver Transplantation, Instituto de Cardiologia do Distrito Federal (ICDF), Setor HFA Hospital das Forças Armadas, Brasilia, Federal District, Brazil; Department of Liver Transplantation, Hospital Brasilia, Setor de Habitações Individuais Sul, Brasilia, Federal District, Brazil
| | - Gabriel Cajá
- Department of Liver Transplantation, Instituto de Cardiologia do Distrito Federal (ICDF), Setor HFA Hospital das Forças Armadas, Brasilia, Federal District, Brazil; Department of Liver Transplantation, Hospital Brasilia, Setor de Habitações Individuais Sul, Brasilia, Federal District, Brazil
| | - Raquel Ullmann
- Department of Liver Transplantation, Instituto de Cardiologia do Distrito Federal (ICDF), Setor HFA Hospital das Forças Armadas, Brasilia, Federal District, Brazil; Department of Liver Transplantation, Hospital Brasilia, Setor de Habitações Individuais Sul, Brasilia, Federal District, Brazil
| | - Ana Virgínia Figueira
- Department of Liver Transplantation, Instituto de Cardiologia do Distrito Federal (ICDF), Setor HFA Hospital das Forças Armadas, Brasilia, Federal District, Brazil; Department of Liver Transplantation, Hospital Brasilia, Setor de Habitações Individuais Sul, Brasilia, Federal District, Brazil
| | - Tiago Morato
- Department of Liver Transplantation, Instituto de Cardiologia do Distrito Federal (ICDF), Setor HFA Hospital das Forças Armadas, Brasilia, Federal District, Brazil; Department of Liver Transplantation, Hospital Brasilia, Setor de Habitações Individuais Sul, Brasilia, Federal District, Brazil
| | - Adriano Moraes
- Department of Liver Transplantation, Instituto de Cardiologia do Distrito Federal (ICDF), Setor HFA Hospital das Forças Armadas, Brasilia, Federal District, Brazil
| | - Juan Rafael Branez Pereira
- Department of Liver Transplantation, Instituto de Cardiologia do Distrito Federal (ICDF), Setor HFA Hospital das Forças Armadas, Brasilia, Federal District, Brazil
| | - Marcelo Perosa
- Department of Liver Transplantation, Instituto de Cardiologia do Distrito Federal (ICDF), Setor HFA Hospital das Forças Armadas, Brasilia, Federal District, Brazil
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7
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Watanabe ALC, Feijó MS, Menezes VPLD, Galdino-Vasconcelos MR, Caballero JLS, Ferreira G, Jorge F, Trevizoli N, Diaz LG, Campos PBD, Cajá G, Ullmann R, Figueira AV, Morato T, Moraes A, Pereira JRB, Perosa M. 500 Consecutive Liver Transplants: The Outcomes of a New Transplantation Program in the Middle West of Brazil. Transplant Proc 2021; 53:73-82. [DOI: https:/doi.org/10.1016/j.transproceed.2020.06.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/29/2023]
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8
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Lim M, Rhu J, Kim S, Lee S, Kim JM, Choi GS, Joh JW. Early reoperation after adult living-donor liver transplantation is associated with poor survival. KOREAN JOURNAL OF TRANSPLANTATION 2019; 33:128-134. [PMID: 35769981 PMCID: PMC9188941 DOI: 10.4285/jkstn.2019.33.4.128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Revised: 12/06/2019] [Accepted: 12/19/2019] [Indexed: 11/04/2022] Open
Abstract
Background Patients who undergo reoperation after living-donor liver transplantation (LDLT) have poor outcomes. However, the specific outcomes of patients undergoing reoperation due to gastrointestinal (GI) tract-related complications following adult LDLT are relatively unknown. In the present study, we investigated the relationship between the causes and outcomes of reoperation after LDLT and classified the risk groups. Methods We performed a retrospective analysis of 506 patients who underwent LDLT at Samsung Medical Center in Seoul between 2010 and 2016. Results Among 506 adult LDLT recipients, 98 (19.4%) underwent reoperation. The causes for reoperation included bleeding (n=39, 39.8%), vascular complications (n=26, 26.5%), wound complications (n=12, 12.2%), bile leakage (n=7, 7.1%), GI tract complications (n=6, 6.1%), and others (n=8, 8.1%). Based on a multivariate analysis, we identified prolonged operation time, hospitalization days, and a history of previous hepatocellular carcinoma-related operation as independent risk factors for reoperation. Patient survival after 3 months, 1 year, 3 years, and 5 years was 96.3%, 90.6%, 82.5%, and 79.4% in the non-reoperation group and 95.9%, 82.7%, 72.8% and 69.3% in the reoperation group, respectively. Patient survival in the reoperation group was significantly lower than that in the non-reoperation group (P=0.018). In the reoperation group, the survival rates of patients with GI tract-related complications—including bile leakage and GI tract complications—were significantly worse than those of patients with non-GI tract-related complications such as bleeding, vascular complications, and wound complications (P<0.001). Conclusions Our results showed that patient outcomes are poor after early reoperation after LDLT and that patients with GI tract-related complications have a higher risk of mortality.
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Affiliation(s)
- Manuel Lim
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jinsoo Rhu
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sangjin Kim
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seohee Lee
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jong Man Kim
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Gyu-Seong Choi
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jae-Won Joh
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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9
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Ford JS, Wise ES, Rehman SC, Jacomino KG, Maggart MJ, Izmaylov M, Geevarghese SK. Obesity in Liver Transplantation: A Risk Factor for Unplanned Reoperation and Prolonged Operative Time. Am Surg 2019. [DOI: 10.1177/000313481908500850] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Selection of orthotopic liver transplantation (OLT) candidates is increasingly inclusive of patients with high BMI. We aim to characterize the influence of obesity on the surgical outcome measures of prolonged operative time and unplanned reoperation. We reviewed the records of obese and normal weight OLT recipients over a 10-year period from a single institution. Variables that trended ( P < 0.1) with endpoints on univariate analysis were put into multivariate logistic regression models to determine independent association ( P < 0.05). We included 195 obese and 171 normal weight OLT recipients in our study. On multivariate analysis, obesity was the only preoperative risk factor that trended with unplanned reoperation (odds ratio 2, P = 0.05). Similarly, only obesity remained independently associated with prolonged length of operation (defined as ≥275 minutes) on multivariate analysis (odds ratio 1.7, P = 0.04). In summary, obesity may make OLT more technically challenging and, thus, represents an independent risk factor for unplanned reoperations and prolonged operative time.
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Affiliation(s)
- James S. Ford
- Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Eric S. Wise
- Department of Surgery, University of Maryland Medical Center, Baltimore, Maryland; and
| | - Saad C. Rehman
- Vanderbilt University School of Medicine, Nashville, Tennessee
| | | | | | | | - Sunil K. Geevarghese
- Division of Hepatobiliary Surgery and Liver Transplantation, Vanderbilt University Medical Center, Nashville, Tennessee
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10
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Baccarani U, Pravisani R, Isola M, Mocchegiani F, Lauterio A, Righi E, Magistri P, Corno V, Adani GL, Lorenzin D, Di Sandro S, Pagano D, Bassetti M, Gruttadauria S, Colledan M, De Carlis L, Vivarelli M, Di Benedetto F, Risaliti A. Early post-liver transplant surgical morbidity in HIV-infected recipients: risk factor for overall survival? A nationwide retrospective study. Transpl Int 2019; 32:1044-1052. [PMID: 31050044 DOI: 10.1111/tri.13446] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Revised: 02/13/2019] [Accepted: 04/25/2019] [Indexed: 12/15/2022]
Abstract
The aim of the study was to analyse the risk factors for early surgical complications requiring relaparotomy and the related impact on overall survival (OS) in HIV-infected patients submitted to liver transplantation. Thus a retrospective investigation was conducted on a nationwide multicentre cohort of 157 HIV patients submitted to liver transplantation in six Italian Transplant Units between 2004 and 2014. An early relaparotomy was performed in 24.8% of cases and the underlying clinical causes were biliary leak (8.2%), bleeding (8.2%), intestinal perforation (4.5%) and suspect of vascular complications(3.8%). No differences in terms of prevalence for either overall or cause-specific early relaparotomies were noted when compared with a non-HIV control group, matched for MELD, recipient age, HCV-RNA positivity and HBV prevalence. While in the control group an early relaparotomy appeared a negative prognostic factor, such impact on OS was not noted in HIV recipients. Nonetheless increasing number of relaparotomies were associated with decreased survival. In multivariate analysis, preoperative refractory ascites and Roux-en-Y choledochojejunostomy reconstruction were significant risk factors for early relaparotomy. To conclude, in HIV liver transplanted patients, an increasing number of early relaparotomies because of surgical complications does negatively affect the OS. Preoperative refractory ascites reflecting a severe portal hypertension and a difficult biliary tract reconstruction requiring a Roux-en-Y choledochojejunostomy are associated with increased risk of early relaparotomy.
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Affiliation(s)
- Umberto Baccarani
- Liver-Kidney Transplant Unit, ASUIUD, Udine, Italy.,Department of Medicine, University of Udine, Udine, Italy
| | - Riccardo Pravisani
- Liver-Kidney Transplant Unit, ASUIUD, Udine, Italy.,Department of Medicine, University of Udine, Udine, Italy
| | - Miriam Isola
- Division of Medical Statistic, Department of Medicine, University of Udine, Udine, Italy
| | - Federico Mocchegiani
- Clinica di Chirurgia Epato-bilio-pancreatica e dei Trapianti, Dipartimento di Medicina Sperimentale e Clinica, Università Politecnica delle Marche, Ancona, Italy
| | - Andrea Lauterio
- General Surgery & Abdominal Transplantation, ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy
| | - Elda Righi
- Division of Infectious Disease, ASUIUD, Udine, Italy
| | - Paolo Magistri
- Hepatopancreatobiliary Surgery and Liver Transplantation Unit, University of Modena and Reggio Emilia, Modena, Italy
| | - Vittorio Corno
- General Surgery, 4-ASST Papa Giovanni XXIII, Bergamo, Italy
| | | | | | - Stefano Di Sandro
- General Surgery & Abdominal Transplantation, ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy
| | | | - Matteo Bassetti
- Department of Medicine, University of Udine, Udine, Italy.,Division of Infectious Disease, ASUIUD, Udine, Italy
| | | | | | - Luciano De Carlis
- General Surgery & Abdominal Transplantation, ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy.,School of Medicine, University of Milano-Bicocca, Milano, Italy
| | - Marco Vivarelli
- Clinica di Chirurgia Epato-bilio-pancreatica e dei Trapianti, Dipartimento di Medicina Sperimentale e Clinica, Università Politecnica delle Marche, Ancona, Italy
| | - Fabrizio Di Benedetto
- Hepatopancreatobiliary Surgery and Liver Transplantation Unit, University of Modena and Reggio Emilia, Modena, Italy
| | - Andrea Risaliti
- Liver-Kidney Transplant Unit, ASUIUD, Udine, Italy.,Department of Medicine, University of Udine, Udine, Italy
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11
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Elsabbagh AM, Girlanda R, Hawksworth J, Pichert MD, Williams C, Pozzi A, Kroemer A, Nookala A, Smith C, Matsumoto CS, Fishbein TM. Impact of early reoperation on graft survival after liver transplantation: Univariate and multivariate analysis. Clin Transplant 2018; 32:e13228. [PMID: 29478256 DOI: 10.1111/ctr.13228] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/19/2018] [Indexed: 12/28/2022]
Abstract
BACKGROUND Data on rate, risk factors, and consequences of early reoperation after liver transplantation are still limited. STUDY DESIGN Single-center retrospective analysis of data of 428 patients, who underwent liver transplantation in period between January 2009 and December 2014. Univariate and multivariate analysis were used to study the risk factors of early reoperation and its impact on graft survival. RESULTS Of 428 patients, 74 (17.3%) underwent early reoperation. Of them, 46 (62.2%) underwent reoperation within the first week and 28 (37.8%) underwent reoperation later than 1 week after transplantation. With multivariate analysis, significant risk factors of early reoperation included pretransplant ICU admission, previous abdominal surgery and diabetes. Early reoperation itself was not found to be an independent predictor of graft loss. However, early reoperation later than 7 days from transplant was found to be independent predictor of graft loss (odds ratio [OR] = 5.125; 95% CI, 1.358-19.552; P = .016). In our series, other independent predictors of graft loss were MELD score (P = .010) and operative time (P = .048). CONCLUSIONS This analysis demonstrates that early reoperations later than a week appear to negatively impact the graft survival. The timing of early reoperation should be a focus of additional studies.
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Affiliation(s)
- Ahmed M Elsabbagh
- MedStar Georgetown Transplant Institute, Georgetown University Hospital, Washington, DC, USA.,Gastroenterology Surgical Center, Department of Surgery, Mansoura University, Mansoura, Egypt
| | - Raffaele Girlanda
- MedStar Georgetown Transplant Institute, Georgetown University Hospital, Washington, DC, USA
| | - Jason Hawksworth
- MedStar Georgetown Transplant Institute, Georgetown University Hospital, Washington, DC, USA
| | - Matthew D Pichert
- MedStar Georgetown Transplant Institute, Georgetown University Hospital, Washington, DC, USA
| | - Cassie Williams
- MedStar Georgetown Transplant Institute, Georgetown University Hospital, Washington, DC, USA
| | - Agostino Pozzi
- MedStar Georgetown Transplant Institute, Georgetown University Hospital, Washington, DC, USA
| | - Alexander Kroemer
- MedStar Georgetown Transplant Institute, Georgetown University Hospital, Washington, DC, USA
| | - Anupama Nookala
- MedStar Georgetown Transplant Institute, Georgetown University Hospital, Washington, DC, USA
| | - Coleman Smith
- MedStar Georgetown Transplant Institute, Georgetown University Hospital, Washington, DC, USA
| | - Cal S Matsumoto
- MedStar Georgetown Transplant Institute, Georgetown University Hospital, Washington, DC, USA
| | - Thomas M Fishbein
- MedStar Georgetown Transplant Institute, Georgetown University Hospital, Washington, DC, USA
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12
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Serper M, Bittermann T, Rossi M, Goldberg DS, Thomasson AM, Olthoff KM, Shaked A. Functional status, healthcare utilization, and the costs of liver transplantation. Am J Transplant 2018; 18:1187-1196. [PMID: 29116679 DOI: 10.1111/ajt.14576] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Revised: 10/30/2017] [Accepted: 10/30/2017] [Indexed: 01/25/2023]
Abstract
The Model for End-Stage Liver Disease (MELD) score predicts higher transplant healthcare utilization and costs; however, the independent contribution of functional status towards costs is understudied. The study objective was to evaluate the association between functional status, as measured by Karnofsky Performance Status (KPS), and liver transplant (LT) costs in the first posttransplant year. In a cohort of 598 LT recipients from July 1, 2009 to November 30, 2014, multivariable models assessed associations between KPS and outcomes. LT recipients needing full assistance (KPS 10%-40%) vs being independent (KPS 80%-100%) were more likely to be discharged to a rehabilitation facility after LT (22% vs 3%) and be rehospitalized within the first posttransplant year (78% vs 57%), all P < .001. In adjusted generalized linear models, in addition to MELD (P < .001), factors independently associated with higher 1-year post-LT transplant costs were older age, poor functional status (KPS 10%-40%), living donor LT, pre-LT hemodialysis, and the donor risk index (all P < .001). One-year survival for patients in the top cost decile was 83% vs 93% for the rest of the cohort (log rank P < .001). Functional status is an important determinant of posttransplant resource utilization; therefore, standardized measurements of functional status should be considered to optimize candidate selection and outcomes.
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Affiliation(s)
- Marina Serper
- Division of Gastroenterology & Hepatology, University of Pennsylvania, Philadelphia, PA, USA
| | - Therese Bittermann
- Division of Gastroenterology & Hepatology, University of Pennsylvania, Philadelphia, PA, USA
| | - Michael Rossi
- Corporate Finance, Decision Support & Reimbursement, University of Pennsylvania Health System, Philadelphia, PA, USA
| | - David S Goldberg
- Division of Gastroenterology & Hepatology, University of Pennsylvania, Philadelphia, PA, USA.,Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, PA, USA
| | - Arwin M Thomasson
- Division of Transplant Surgery, University of Pennsylvania, Philadelphia, PA, USA
| | - Kim M Olthoff
- Division of Transplant Surgery, University of Pennsylvania, Philadelphia, PA, USA
| | - Abraham Shaked
- Division of Transplant Surgery, University of Pennsylvania, Philadelphia, PA, USA
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13
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Moghadamyeghaneh Z, Alameddine M, Jue JS, Guerra G, Selvaggi G, Nishida S, Fan J, Beduschi T, Vianna R. A nationwide analysis of re-exploration after liver transplant. HPB (Oxford) 2018; 20:216-221. [PMID: 29129486 DOI: 10.1016/j.hpb.2017.08.024] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Revised: 08/12/2017] [Accepted: 08/29/2017] [Indexed: 12/12/2022]
Abstract
BACKGROUND A retrospective review to investigate rate and outcomes of re-exploration following liver transplantation in the United States. METHODS The NIS database was used to examine outcomes of patients who underwent re-exploration following liver transplantation from 2002 to 2012. Multivariate regression analysis was performed to compare outcomes of patients with and without reoperation. RESULTS We sampled a total of 12,075 patients who underwent liver transplantation. Of these, 1505 (12.5%) had re-exploration during the same hospitalization. Hemorrhagic (67.9%) and biliary tract anastomosis complication (14.8%) were the most common reasons for reoperation. Patients with reoperation had a significantly higher mortality than those who did not (11.6% vs. 3.8%, AOR: 3.01, P < 0.01). Preoperative coagulopathy (AOR: 1.71, P < 0.01) and renal failure (AOR: 1.57, P < 0.01) were associated with hemorrhagic complications. Peripheral vascular disorders (AOR: 2.15, P < 0.01) and coagulopathy (AOR: 1.32, P < 0.01) were significantly associated with vascular complications. Risk of wound disruption was significantly higher in patients with chronic pulmonary disease (AOR: 1.50, P < 0.01). CONCLUSION Re-exploration after liver transplantation is relatively common (12.5%), with hemorrhagic complication as the most common reason for reoperation. Preoperative coagulation disorders significantly increase hemorrhagic and vascular complications. Further clinical trails should investigate prophylactic strategies in high risk patients to prevent unplanned reoperation.
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Affiliation(s)
- Zhobin Moghadamyeghaneh
- Department of Surgery, Division of Transplant Surgery, Jackson Memorial Hospital/University of Miami, Miami, FL, USA
| | - Mahmoud Alameddine
- Department of Surgery, Division of Transplant Surgery, Jackson Memorial Hospital/University of Miami, Miami, FL, USA
| | - Joshua S Jue
- Department of Surgery, Division of Transplant Surgery, Jackson Memorial Hospital/University of Miami, Miami, FL, USA
| | - Giselle Guerra
- Department of Surgery, Division of Transplant Surgery, Jackson Memorial Hospital/University of Miami, Miami, FL, USA
| | - Gennaro Selvaggi
- Department of Surgery, Division of Transplant Surgery, Jackson Memorial Hospital/University of Miami, Miami, FL, USA
| | - Seigo Nishida
- Department of Surgery, Division of Transplant Surgery, Jackson Memorial Hospital/University of Miami, Miami, FL, USA
| | - J Fan
- Department of Surgery, Division of Transplant Surgery, Jackson Memorial Hospital/University of Miami, Miami, FL, USA
| | - Thiago Beduschi
- Department of Surgery, Division of Transplant Surgery, Jackson Memorial Hospital/University of Miami, Miami, FL, USA
| | - Rodrigo Vianna
- Department of Surgery, Division of Transplant Surgery, Jackson Memorial Hospital/University of Miami, Miami, FL, USA.
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14
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Posner AD, Sultan ST, Zaghloul NA, Twaddell WS, Bruno DA, Hanish SI, Hutson WR, Hebert L, Barth RN, LaMattina JC. Resolution of donor non-alcoholic fatty liver disease following liver transplantation. Clin Transplant 2017. [PMID: 28636211 DOI: 10.1111/ctr.13032] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Transplant surgeons conventionally select against livers displaying high degrees (>30%) of macrosteatosis (MaS), out of concern for primary non-function or severe graft dysfunction. As such, there is relatively limited experience with such livers, and the natural history remains incompletely characterized. We present our experience of transplanted livers with high degrees of MaS and microsteatosis (MiS), with a focus on the histopathologic and clinical outcomes. METHODS Twenty-nine cases were identified with liver biopsies available from both the donor and the corresponding liver transplant recipient. Donor liver biopsies displayed either MaS or MiS ≥15%, while all recipients received postoperative liver biopsies for cause. RESULTS The mean donor MaS and MiS were 15.6% (range 0%-60%) and 41.3% (7.5%-97.5%), respectively. MaS decreased significantly from donor (M=15.6%) to recipient postoperative biopsies (M=0.86%), P<.001. Similarly, MiS decreased significantly from donor biopsies (M=41.3%) to recipient postoperative biopsies (M=1.8%), P<.001. At a median of 68 days postoperatively (range 4-384), full resolution of MaS and MiS was observed in 27 of 29 recipients. CONCLUSIONS High degrees of MaS and MiS in donor livers resolve in recipients following liver transplantation. Further insight into the mechanisms responsible for treating fatty liver diseases could translate into therapeutic targets.
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Affiliation(s)
- Andrew D Posner
- University of Maryland School of Medicine, Baltimore, MD, USA
| | - Samuel T Sultan
- Division of Transplantation, University of Maryland School of Medicine, Baltimore, MD, USA
| | | | | | - David A Bruno
- Division of Transplantation, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Steven I Hanish
- Division of Transplantation, University of Maryland School of Medicine, Baltimore, MD, USA
| | | | - Laci Hebert
- Division of Transplantation, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Rolf N Barth
- Division of Transplantation, University of Maryland School of Medicine, Baltimore, MD, USA
| | - John C LaMattina
- Division of Transplantation, University of Maryland School of Medicine, Baltimore, MD, USA
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15
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Berumen J, Misel M, Vodkin I, Halldorson JB, Mekeel KL, Hemming A. The effects of Share 35 on the cost of liver transplantation. Clin Transplant 2017; 31. [DOI: 10.1111/ctr.12937] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/19/2017] [Indexed: 01/31/2023]
Affiliation(s)
- Jennifer Berumen
- Department of Surgery; University of California San Diego; San Diego CA USA
| | - Michael Misel
- Department of Surgery; University of California San Diego; San Diego CA USA
| | - Irine Vodkin
- Department of Hepatology; University of California San Diego; San Diego CA USA
| | | | - Kristin L. Mekeel
- Department of Surgery; University of California San Diego; San Diego CA USA
| | - Alan Hemming
- Department of Surgery; University of California San Diego; San Diego CA USA
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16
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Yang J, Kim DY, Lee SK, Kim G. Recurrent Cardiac Arrest during a Nontransplant Operation Due to Variant Angina in a Liver Transplantation Patient. KOREAN JOURNAL OF TRANSPLANTATION 2016. [DOI: 10.4285/jkstn.2016.30.3.143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Jaeyoung Yang
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Dae Yoon Kim
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Suk Koo Lee
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Gaabsoo Kim
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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