BACKGROUND: Liver transplantation is the most extreme form of surgical management of patients with hepatic trauma, with very limited literature data supporting its use. The aim of this study was to assess the results of liver transplantation for hepatic trauma. METHODS: This retrospective analysis based on European Liver Transplant Registry comprised data of 73 recipients of liver transplantation for hepatic trauma performed in 37 centers in the period between 1987 and 2013. Mortality and graft loss rates at 90 days were set as primary and secondary outcome measures, respectively. RESULTS: Mortality and graft loss rates at 90 days were 42.5% and 46.6%, respectively. Regarding general variables, cross-clamping without extracorporeal veno-venous bypass was the only independent risk factor for both mortality (P = 0.031) and graft loss (P = 0.034). Regarding more detailed factors, grade of liver trauma exceeding IV increased the risk of mortality (P = 0.005) and graft loss (P = 0.018). Moreover, a tendency above the level of significance was observed for the negative impact of injury severity score (ISS) on mortality (P = 0.071). The optimal cut-off for ISS was 33, with sensitivity of 60.0%, specificity of 80.0%, positive predictive value of 75.0%, and negative predictive value of 66.7%. CONCLUSIONS: Liver transplantation seems to be justified in selected patients with otherwise fatal severe liver injuries, particularly in whom cross-clamping without extracorporeal bypass can be omitted. The ISS cutoff less than 33 may be useful in the selection process.

Department of General Transplant and Liver Surgery Medical University of Warsaw Warsaw Poland 2 Hepato Biliary Center AP HP Paul Brousse Hospital University Paris Sud Villejuif France 3 Division of Hepatopancreatobiliary and Transplantation Surgery Department of Surgery Erasmus MC University Medical Centre Rotterdam Rotterdam The Netherlands 4 Department of General Visceral and Transplantation Surgery Hannover Medical School Hannover Germany 5 Department of General Surgery and Transplantation Sant'Orsola Malpighi Hospital University of Bologna Bologna Italy 6 Hepato Pancreato Biliary Surgery and Liver Transplantation Unit Department of Surgery and Transplantation University of Modena and Reggio Emilia Modena Italy 7 Hepatobiliary Surgery and Liver Transplantation University of Pisa Medical School Hospital Pisa Italy 8 Department of General and Visceral Surgery University Hospital of Muenster Muenster Germany 9 Department of Transplantation Oslo University Hospital Rikshospitalet Oslo Norway 10 Unit of Surgery and Liver Transplantation Hospital Universitario Reina Sofia Córdoba Spain 11 Transplant Institute Sahlgrenska University Hospital Sahlgrenska Academy Gothenburg Sweden 12 Department of Abdominal Visceral and Transplantation Surgery Charité Universitätsmedizin Campus Virchow Berlin Germany 13 Department of General and Transplant Surgery University Hospital Essen Essen Germany 14 Department of General Visceral and Vascular Surgery Jena University Hospital Jena Germany 15 Unità Operativa Chirurgia Generale e Trapianti di Fegato Fondazione IRCCS Ospedale Maggiore Policlinico Mangiagalli e Regina Elena Milan Italy 16 Liver Transplant Center General Surgery Unit A O Città della Salute e della Scienza Molinette Hospital University of Turin Turin Italy 17 Liver Transplant Unit Hospital Juan Canalejo La Coruna Spain 18 Abdominal Trasplant Unit Universitary Clinical Hospital Santiago de Compostela Spain 19 Hepatic Biliary Pancreatic Surgery and Liver Transplant Unit University Hospital Virgen del Rocío of Seville Seville Spain 20 Abdominal Transplant Surgery University Hospitals Leuven Leuven Belgium 21 Department of Abdominal Surgery and Transplantation Centre Hospitalier Universitaire de Liège University of Liège Liège Belgium 22 Department of Visceral and Transplantation Surgery University Hospitals Geneva Switzerland 23 Center of Cardiovascular Surgery and Transplantations Brno Czech Republic 24 Department of General and Visceral Surgery Goethe University Hospital and Clinics Frankfurt Germany 25 Department of Visceral Transplant Vascular and Thoracic Surgery University Hospital of Leipzig Leipzig Germany 26 Department of General Visceral and Transplant Surgery University Hospital Tübingen Tübingen Germany 27 Service de Chirurgie Digestive et Transplantation University Lille Nord de France Centre Hospitalier Universitaire Lille Lille France 28 The Liver Unit Queen Elizabeth Hospital Birmingham Edgbaston Birmingham United Kingdom 29 Institute of General Surgery and Liver Transplantation Department of Emergency and Organ Transplantation University of Bari Bari Italy 30 Department of Surgery Pope John XXIII Hospital Bergamo Italy 31 Department of Experimental Medicine and Surgery Section of Transplantation Tor Vergata University of Rome Rome Italy 32 Division of Transplantation Department of Surgery Leiden University Medical Center Leiden University Leiden The Netherlands 33 Department of Surgery and Organ Transplantation Porto Portugal 34 Department of HBP Surgery and Transplant Hospital Universitari Vall d'Hebro'n Autonomous University of Barcelona Barcelona Spain 35 Service of General and Digestive Surgery and Abdominal Organ Transplantation Doce de Octubre University Hospital Madrid Spain 36 Liver Unit Gregorio Marañón University Hospital Madrid Spain 37 Unidad de Trasplante Hepatico Hospital Universitarro Puerta de Hierro Madrid Spain 38 Hepatobiliopancreatic Surgery and Transplantation Unit La Fe University Hospital Valencia Spain 39 Inonu University Liver Transplantation Institute Malatya Turkey

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