Liver transplantation for severe hepatic trauma: Experience from a single center

Table 1 Liver injury scale (AAST)

Grade		Description
I	Hematoma	Subcapsular, < 10% surface area
	Laceration	Capsular tear, < 1 cm parenchymal depth
II	Hematoma	Subcapsular, 10%-50% surface area: intraparenchymal, < 10 cm in diameter
	Laceration	1-3 cm parenchymal depth, < 10 cm in length
III	Hematoma	Subcapsular, > 50% surface area or expanding; ruptured subcapsular or intraparenchymal hematoma > 10 cm or expanding
	Laceration	> 3 cm parenchymal depth
IV	Laceration	Parenchymal disruption involving 25%-75% of hepatic lobe or 1-3 Couinaud's segments within a single lobe
V	Laceration	Parenchymal disruption involving > 75% of hepatic lobe or > 3 Couinaud’s segments within a single lobe
	Vascular	Juxtahepatic venous injuries; i.e. retrohepatic vena cava/central major hepatic veins
VI	Vascular	Hepatic avulsion

Table 2 Type of injury, operations performed and patient outcome

Patient	Age	Injury	Primary operation	Indication for OLT	Re-transplant	Outcome
1	25	Gun shot wound right lobe	Packing, hepatic artery ligation	Acute liver failure	No	Died (cerebral edema)
2	68	Blunt trauma subcapsular hematoma right lobe	R lobectomy, failed portal vein thrombectomy	Portal thrombosis progressive liver failure	No	Discharged POD 45
3	58	Gun-shot wound right lobe, A-V fistula	Hepatorraphy, duodenal repair, embolization	Portal hypertension (A-V fistula), left portal vein thrombosis	Yes	Alive at 11 yr
4	35	Gun-shot wound left lateral lobe, hepatic artery pseudoaneurysm	Packing, embolization	Liver gangrene	No	Discharged POD 85