**3.1 Statistics (I)**

From 1993 until 2001, data were collected and entered on paper sheets. Since 2002, data collection was done with internet-based data entry software with integrated plausibility checks. The anonymized data were analyzed with the statistical program SPSS (Version 14, Chicago, USA). Incidences are presented with counts and percentages, continuous values with mean and standard deviation (SD). Analysis was mainly restricted to descriptive statistics. Statistical tests were avoided due to the multiple comparisons (several groups and outcome parameters), as well as the high sample size which could lead to irrelevant significances. In selected situations only, data from the group with liver trauma were compared statistically against the remaining groups (χ² test for incidence rates and U-test for continuous values).


\*Note–AIS-98 = Abbreviated Injury Scale, 1998 version.

Table 1. American Association for the Surgery of Trauma (AAST) -scale and modified scale for classification of liver injuries

#### **3.2 Transplantation after blunt trauma to the liver**

Our study was aimed to critically question the indication of LT on the basis of blunt and uncontrollable liver trauma; we therefore report our experience with 4 patients who all underwent LT due to accident-caused uncontrollable acute liver trauma at our center along with a comparison and discussion of our results based on the current literature.

From September 1987 to December 2008, our center performed 1,529 LT (6 traumatic and 1,523 others in 4 and 1,475 patients, respectively). Apart from transplant surgery, the clinic's second major focus is on hepatobiliary surgery. In this analysis the following eligibility criteria were used:

1. patients ≥ 18 years;

306 Liver Transplantation – Basic Issues

statistics. Statistical tests were avoided due to the multiple comparisons (several groups and outcome parameters), as well as the high sample size which could lead to irrelevant significances. In selected situations only, data from the group with liver trauma were compared statistically against the remaining groups (χ² test for incidence rates and U-test for

**Grade Injury Injury Description AIS-98\*** 

hematoma subcapsular, 10–50% surface;

hematoma subcapsular, >50% surface;

laceration capsular tear, 1–3cm parenchymal depth, <10cm

hematoma subcapsular, <10% surface 2

laceration capsular tear, <1cm parenchymal depth 2

laceration >3cm parenchymal depth 3

parenchymal disruption involving 25–75% of hepatic lobe or 1–3 segments

parenchymal disruption involving >75% of hepatic lobe or >3 segments within a single lobe

vascular hepatic venous injuries 5

VI vascular hepatic avulsion 6

Table 1. American Association for the Surgery of Trauma (AAST) -scale and modified scale

Our study was aimed to critically question the indication of LT on the basis of blunt and uncontrollable liver trauma; we therefore report our experience with 4 patients who all underwent LT due to accident-caused uncontrollable acute liver trauma at our center along

From September 1987 to December 2008, our center performed 1,529 LT (6 traumatic and 1,523 others in 4 and 1,475 patients, respectively). Apart from transplant surgery, the clinic's

with a comparison and discussion of our results based on the current literature.

intraparenchymal hematoma, <10cm in diameter <sup>2</sup>

intraparenchymal hematoma, >10cm in diameter <sup>3</sup>

length <sup>2</sup>

**Grade** 

4

5

continuous values).

**AAST** 

I

II

III

V

IV laceration

for classification of liver injuries

laceration

\*Note–AIS-98 = Abbreviated Injury Scale, 1998 version.

**3.2 Transplantation after blunt trauma to the liver** 


The transplantations conformed to the local ethical guidelines and followed the ethical guidelines of the 1975 Declaration of Helsinki. LT was indicated in cases of uncontrollable liver injuries. It was considered contraindicated in cases of irreversible cerebral damage (i.e. slight cerebral edema is not considered a contraindication), absence of uncontrolled extrahepatic infection (i.e. no SIRS), absence of uncontrolled multiple organ failure (MOF) (less than 3 organs including the liver).

In order to offer the best sized organ in a timely fashion, the following surgical procedures were considered for all recipients when available: deceased donor liver transplantation (DDLT) (full size and split-left lateral, left, right, extended right) and living donor liver transplantation (LDLT) (left lateral, left, right).

The conservative management of our patients consisted of: a) causal therapy, b) intense monitoring of hemodynamic, respiratory, renal, neurological, infectious, hepatic and metabolic parameters, c) minimal handling and no sedation whenever possible, d) fluid restriction but enough fluid to assure cerebral perfusion, e) hypercaloric protein-free nutrition, f) intestinal sterilization with Neomycine and Lactulose, g) fresh frozen plasma in cases of coagulation disorder. All patients received immunosuppressive induction with Prednisolone. Maintenance immunosuppression consisted of a dual therapy with calcineurin inhibitors and Prednisolone post-transplant.

We monitored the peri-operative course of each patient and noted short-term and long-term outcomes. The end of follow-up for this study was the end of July 2009.
