Recovery of bowel function after liver transplant surgery
Mohamed A, Safwan M, Tinney F, Collins K, Rizzari M, Yoshida A, Abouljoud MS, and Nagai S. Recovery of bowel function after liver transplant surgery. Hepatology 2018; 68(S1):470A.
Background: Prolonged postoperative ileus (PPOI) is a common complication after major abdominal surgery. In liver transplant surgery, the portal vein is clamped which leads to bowel congestion. Additionally, factors such as perioperative medications often affect postoperative bowel function recovery. However, factors contributing to PPOI in liver transplant patients has not been fully elucidated. Methods: This is a retrospective study of patients who received liver transplantation at a single institutional between 2016 and 2017. A total of 101 patients were evaluated. Anhepatic time was defined as the time from portal vein clamp to liver graft reperfusion. One patient required veno-venous bypass, and was excluded. This allowed for anhepatic time to be considered as the bowel congestion time. PPOI was determined clinically either by symptomatology, or with radiographic assistance in the form of an abdominal x-ray or computed tomography of the abdomen. Intraoperative variables such as anhepatic time (=bowel congestion time), cold ischemia time (CIT), warm ischemia time (WIT), transfusion requirements, and pressor requirements were analyzed. Postoperative variables such as time to first bowel movement, duration intravenous (IV) or enteral (PO) narcotic usage, and length of hospital stay were analyzed. Graft survival and patient survival was also analyzed. Results: Median time to first bowel movement was 4 days. Patients on 0-2 pressors by the end of the case had bowel movements earlier, when compared to patients on 3-4 pressors (3±3.4 days vs. 3.8±1.6 days, P=0.007). Longer anhepatic times did not correlate to longer times to first bowel movement postoperatively (3±2.5 days for <80min vs. 4.0±1.7 days for >=80min, P=0.502). Of the 100 patients, 22 patients (22%) were diagnosed as having a PPOI. Median (IQR) anhepatic time was significantly shorter in the PPOI group (67 [55.5-78] min vs. 79 [66-98] min, P =0.004). There was no difference in other intraoperative factors. Median (IQR) duration of postoperative intravenous narcotics (IV) and oral narcotics (PO) were significantly longer in the PPOI group (IV, 6 [2-8.5] days vs. 3 [2-6] days, P=0.034; PO, 9.5 [6.3-15] days vs. 6 [4-8] days, P=0.001). To predict PPOI, the cut-off duration of IV and PO narcotics was 6.5 days (AUC 0.648) and 7.5 days (AUC 0.724), respectively. Based on a logistic multivariable regression model, usage of PO narcotics 8 days or longer was considered an independent risk factor for PPOI (odds ratio=3.747, 95%CI=1.108-12.673, P=0.034) (Table 1). Length of hospital stay was significantly longer in the PPOI group (12.5 [8.75-23.5] days vs. 8 [6-12] days, P <0.001). Graft or patient survival was not affected by PPOI (P=0.519 and 0.189, respectively). Conclusion: Although possible association was expected, longer anhepatic times did not adversely affect postoperative recovery of bowel function. Shortening the duration of PO narcotics may shorten patient hospital stay.