Prior abdominal surgery is associated with increased complexity of liver transplantation (LT), but this represents a heterogenous cohort. We sought to quantify the intraoperative impact of prior abdominal surgery in LT.

Our prospective LT database (2012-2023) was analysed, comparing patients based on location of prior surgery (re-transplant, hepatobiliary, other abdominal) and method of entry (open, laparoscopic). Primary outcomes were operating time (OT) and transfusion requirements (PC). Statistical analysis included ANOVA and Chi-square tests ( p< 0.05) and multivariate regression to control for covariates.

771 patients were included. Mean operative time for patients without prior abdominal surgery was 33.05±111min, significantly lower than those who had undergone re-transplantation (435±150.5, p< 0.001), hepatobiliary (386.5±119.8, p< 0.001) or any open abdominal surgery (391.4±124.4, p =0.013). Transfusion requirements without prior surgery were 5.24±4.9units, lower compared to re-transplantation (12.49±13.7, p < 0.001), hepatobiliary (7.57±5.2, p < 0.001) or open surgery (8.49±10.2, p < 0.001). No similar associations were observed in patients who had previous laparoscopic (OT 355.7±121.8; PC 5.81±6.0, p > 0.05) or non-RUQ surgery (OT 360.3±117.8; PC 6.02±5.6, p > 0.05).

Patients with prior re-transplant, hepatobiliary and open surgery are associated with increased operating time and transfusion, whilst laparoscopic approaches did not worsen outcomes. Planning for these high-risk patients necessitates detailed pre-operative surgical assessment.