Predictors of early recipient mortality after living donor liver transplantation in a tertiary care center in Egypt

Abstract

BACKGROUND: Living donor liver transplantation (LDLT) has evolved into a widely accepted therapeutic option. Many different risk factors may affect early mortality after LDLT.OBJECTIVES: Analyze risk factors that can affect early (<6 months) mortality of patients after LDLT in a single center.DESIGN: Retrospective chart review of patients who underwent LDLT.SETTING: University hospital.PATIENTS AND METHODS: Adult cirrhotic patients who underwent LDLT were classified by early (first 6 months) or late mortality. A full pre, intra- and post-operative evaluation had been done on all patients including a full history, examination and investigations to identify risk factors that might affect mortality post-LDLT.MAIN OUTCOME MEASURES: Determination of pre-, intra- or postoperative factors that might affect recipient mortality post-LDLT.SAMPLE SIZE: 123.RESULTS: Pre-operative factors that increased early mortality in a univariate analysis were higher model for end-stage liver disease (MELD) scores, lower graft-recipient weigh ratio (GRWR), older donor age, and recurrent spontaneous bacterial peritonitis. Intraoperative factors included more transfusion units of blood, plasma, platelets and cryoprecipitate, a longer time for cold and warm ischemia, and a longer anhepatic phase among others. Postoperative factors included a longer ICU or hospital stay and abnormal postoperative laboratory data. In the final logistic regression model, the most significant factors were pre-operative GRWR, length of hospital stay, units of intraoperative blood transfusion, postoperative alanine aminotransferase, postoperative total leukocyte count, and MELD score.CONCLUSION: LDLT outcomes might be improved by attempting to resolve clinical factors that have been identified as contributors to early post-LDLT mortality.LIMITATIONS: More risk factors, such as those relevant to patient portal vein hemodynamics, should be included in an analysis of predictors of early mortality.CONFLICT OF INTEREST: None.

In-hospital mortality of liver transplantation and risk factors: a single-center experience

“…Several factors of recipients have an impact on inhospital mortality. Nafea et al (10) reported that MELD score, preoperative graft-recipient weight ratio, number of intraoperative blood transfusion units, postoperative alanine aminotransferase (ALT) levels, and postoperative total leukocyte counts were significant predictors for early mortality. Other studies have shown that factors of recipients, including high MELD scores (11), several comorbidities (12), advanced age (13), abnormal BMI (14), and low-performance status (15), were correlated with higher perioperative death after LT.…”

Predictive Factors of Early Mortality after Living Donor Liver Transplantation: A Single Center Experience of 780 Cases over 16 Years

“…Early and late survival rates were significantly lower in patients in whom a microorganism was isolated on deep tracheal aspirate culture (31). Other studies did not find any significant association between postoperative morbidities and early mortality after liver transplantation (12,13,15). Avoidance, early detection, and proper management of early postoperative vascular and pulmonary complications are essential to reduce early postoperative mortality.…”

“…Elkholy et al found that sepsis was the commonest cause of early mortality after LDLT (13). Nafea et al found that sepsis followed by acute rejection were the commonest causes of early mortality (15). Li et al reported that multi-organ failure was the commonest cause of early mortality (12).…”

Identification and Internal Validation of a Novel Pre-Transplant Biomarker Panel to Predict Mortality Following Liver Transplantation: The Liver Immune Frailty Index

“…[9][10][11] These physiologic alterations are especially pronounced in patients with high medical acuity. 9,12,13 The state of "physical frailty" associated with ESLD is an inseparable, independent predictor of mortality both prior to 8,9,14 and following liver transplantation. [15][16][17][18][19] Evaluation of frailty parameters is critical in liver transplant candidate assessment, 19 but traditional physical and nutritional assessments are di cult, time consuming, and may exhibit signi cant observer bias, putting their clinical utility and reproducibility into question.…”