Background: Complex liver transplantation is an important issue in clinical. Good prognoses in our study were achieved through precise preoperative planning, comprehensive perioperative treatment, and surgical improvements.
Methods: A retrospective analysis was conducted on 1,435 liver transplant patients treated at the Affiliated Hospital of Qingdao University in China from January 2015 to August 2024. Patients were divided into a complex surgery group (including cases with multi-organ dysfunction, portal vein thrombosis grade III or above, repeat/multiple liver transplants, a history of upper abdominal surgery, large diseased livers) and a standard surgery group. Kaplan-Meier analysis was used to calculate post-retransplant survival rates and generate survival curves, with a significance level of P<0.05.
Results:
1. A total of 388 complex liver transplant cases were performed, accounting for 27.04% of the total.
2. Postoperative survival rates for the complex surgery group at 1 year, 3 years, and 5 years were 82.70%, 65.50%, and 56.70%, respectively. In contrast, the standard surgery group had survival rates of 89.00%, 76.50%, and 69.20% at the same intervals. Survival rates in the standard surgery group were significantly better than those in the complex surgery group (P<0.001).
3. In complex liver transplants: Liver transplants for critically ill patients (e.g., MELD scores ≥30, renal dysfunction, or cardiac dysfunction) totaled 230 cases (16.03%). Perioperative application of CRRT, ECMO, and IABP contributed to good prognoses in these cases. Portal vein thrombosis was present in 206 liver transplant patients, including 84 cases of grade III or higher thrombosis (5.85%). For split liver transplants, routine reconstruction of segment IV portal veins and segments V and VIII hepatic veins increased the effective donor liver volume.
4. Other complex liver transplant scenarios included complex arterial variations, reduced-size liver transplants for large livers, autologous liver transplants, liver transplants for elderly recipients (aged ≥80 years), laparoscopic-assisted liver transplants, and domino liver transplants.
Conclusions:
1. As the number of complex liver transplant cases increases, our center has achieved favorable outcomes through detailed preoperative evaluation, comprehensive perioperative treatment, and meticulous surgical techniques. Although 1-year, 3-year, and 5-year survival rates are slightly lower than those for standard liver transplants, the results remain promising.
2. Complex liver transplantation is a systematic endeavor requiring continuous technical innovation and refinement, as well as the effective use of CRRT, artificial liver systems, and ECMO to improve outcomes for critically ill patients.