Preoperative and Intraoperative Predictors of Postoperative Morbidity, Poor Graft Function, and Early Rejection in 190 Patients Undergoing Liver Transplantation

Abstract

Subjects: A total of 190 adult patients undergoing primary liver transplantation. Main Outcome Measure: Adverse outcome was prospectively defined as either in-hospital death or prolonged postoperative hospitalization (Ͼ14 days) associated with morbidity. Potential preoperative and intraoperative risk factors were collected. Associations were tested by univariate analysis followed by multivariate analysis in which preoperative factors were entered before intraoperative factors. Results: Adverse outcome occurred in 44.7% of patients. Incidences of other complications were as follows: inhospital mortality (8.4%), primary graft nonfunction (4.2%), poor early graft function (1.1%), and early rejection (31.2%). Univariate predictors of adverse outcome were United Network for Organ Sharing status (P=.003), Child-Turcotte-Pugh score (P=.02), POSSUM physiological score (P=.002), recipient age (P=.01), preoperative serum high-density lipoprotein cholesterol level (P=.03), preoperative serum creatinine level (P=.002), preoperative serum total IgG level (P=.004), duration in hospital preoperatively (P=.03), operative duration (PϽ.001), allogeneic erythrocyte transfusions (PϽ.001), total intraoperative fluids (P=.002), and use of inotropic agents (P=.01). In the final multivariate model, predictors of adverse outcome were United Network for Organ Sharing status (P = .03), recipient age (P=.002), and total intraoperative fluids (P=.04). Most patients who died or had a prolonged hospitalization exhibited dysfunction of more than 1 organ system, including pulmonary, renal, and infectious complications. Conclusions: Adverse outcome occurs frequently after liver transplantation, usually involves multiple organ systems, and is predicted in part by several preoperative and intraoperative factors.

Intraoperative blood transfusion requirement is the main determinant of early surgical re-intervention after orthotopic liver transplantation

“…Previous reports have shown a relationship between intraoperative blood loss and morbidity and mortality, as well as a longer stay in the intensive care ward [20,21,22,231. This study clearly indicates the relation between intraoperative blood loss, surgical re-intervention during the in-hospital stay after liver transplantation, and a prolonged in-hospital stay.…”

Reoperative Complications after Primary Orthotopic Liver Transplantation: A Contemporary Single-Center Experience in the Post–Model for End-Stage Liver Disease Era

“…[11][12][13] Although many large series have reported the overall rates of postoperative graft nonfunction; vascular thromboses; and biliary, infectious, and hemorrhagic complications, 5,11,12,[14][15][16][17][18][19] neither the specific management nor the effects of these complications on graft and patient survival are described. This study represents the largest contemporary singlecenter experience to report the scope of reoperative complications after primary liver transplantation and their associations with graft and patient outcomes.…”

Fatores de risco para a falência do transplante ortotópico de fígado no Rio Grande do Sul, Brasil

“…Estudos em países desenvolvidos sugerem que fatores de risco sócio-econômicos, demográficos e clínicos dos receptores aumentam o risco de falência do transplante hepático, principalmente as faixas etárias extremas 17 , a raça negra 18 , o gênero feminino 19 , doença hepática viral grave, paciente com classificação ChildPugh grau C 20 , renda familiar e escolaridade baixa 21,22,23 . Entre os fatores do doador, destacam-se: o óbito por doenças cérebro-vasculares 9,24,25 , idades extremas 26 , gênero feminino, raça negra e, dentre os fatores do procedimento, tempo de isquemia fria do órgão maior que dez horas 14,15,17,27,28,29,30 .…”