Is it safer to perform surgery before or after liver transplantation? A case-match study for colorectal and small-bowel surgery

Colorectal and small bowel surgery in both cirrhosis and transplant patients carries significant risks. Mortality was significantly higher in cirrhosis patients overall, but data suggests the risk of surgery in cirrhosis patients with MELD scores ≤ 14 might be comparable to transplant patients, while those with MELD scores > 14 are at particular risk. Small sample size and heterogeneity of procedures limit these findings; still, the necessity of surgery in patients with higher MELD should be carefully evaluated, as delaying surgery until after liver transplantation may be safer. WHAT DOES THIS PAPER ADD TO LITERATURE? : This paper contains the largest case-matched comparison of surgery in cirrhosis patients with liver transplant patients. We quantify the risk for small bowel and colorectal surgery in comparable patients for the first time, to assist clinical decision of potentially delaying surgery until after liver transplantation.