The effect of prior upper abdominal surgery on outcomes after liver transplantation for hepatocellular carcinoma: An analysis of the database of the organ procurement transplant network

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Orthotopic liver transplantation (OLT) is the preferred treatment for hepatocellular carcinoma (HCC) in select patients. Many patients listed for OLT have a history of prior upper abdominal surgery (UAS). Repeat abdominal surgery increases operative complexity and may cause a greater incidence of complication. This study sought to compare outcomes after liver transplantation for patients with and without prior UAS.


Adult HCC patients undergoing OLT were identified using the database from the Organ Procurement and Transplantation Network (1987–2015). Patients were separated by presence of prior UAS into 2 propensity-matched cohorts. Overall survival (OS) and graft survival (GS) were analyzed by log-rank test and graphed using Kaplan-Meier method. Recipient and donor demographic and clinical characteristics were also studied using Cox regression models.


A total of 15,043 patients were identified, of whom 6,205 had prior UAS (41.2%). After 1:1 propensity score matching, cohorts (UAS versus no UAS) contained 4,669 patients. UAS patients experienced shorter GS (122 months vs 129 months; P < .001) and shorter OS (130 months vs 141 months; P < .001). Median duration of stay for both cohorts was 8 days. Multivariate Cox regression models revealed that prior UAS was associated with an increased hazard ratio (HR) for GS (HR 1.14; 95% confidence interval (CI) 1.06–1.22; P < .001) and OS (HR 1.14; 95% CI 1.06–1.23; P < .001).


Prior UAS is an independent negative predictor of GS and OS after OLT for HCC. OLT performed in patients with UAS remains a well-tolerated and effective treatment for select HCC patients but may alter expected outcomes and influence follow-up protocols.

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