• Medicina intensiva · Oct 2021

    Early postoperative mortality in liver transplant recipients involving indications other than hepatocellular carcinoma. A retrospective cohort study.

    • J C Pozo-Laderas, I Guler, M Rodríguez-Perálvarez, J C Robles, A Mula, P López-Cillero, and C de la Fuente.
    • Intensive Care Medicine, Reina Sofia University Hospital and Maimonides Biomedical Research Institute (IMIBIC), Cordoba, Spain. Electronic address: drjcpozo@hotmail.com.
    • Med Intensiva. 2021 Oct 1; 45 (7): 395-410.

    AimsTo analyze the perioperative differences in a consecutive cohort of liver transplant recipients (LTRs) classified according to the indication of transplantation, and assess their impact upon early mortality 90 days after transplantation.DesignA retrospective cohort study was carried out.ScopeA single university hospital.PatientsA total of 892 consecutive adult LTRs were included from January 1995 to December 2017. Recipients with acute liver failure, retransplantation or with grafts from non-brain death donors were excluded. Two cohorts were analyzed according to transplant indication: hepatocellular carcinoma (HCC-LTR) versus non-carcinoma (non-HCC-LTR).Main Variables Of InterestRecipient early mortality was the primary endpoint. The pretransplant recipient and donor characteristics, surgical time data and postoperative complications were analyzed as independent predictors.ResultsThe crude early postoperative mortality rate related to transplant indication was 13.3% in non-HCC-LTR and 6.6% in HCC-LTR (non-adjusted HR=2.12, 95%CI=1.25-3.60; p=0.005). Comparison of the perioperative features between the cohorts revealed multiple differences. Multivariate analysis showed postoperative shock (HR=2.02, 95%CI=1.26-3.24; p=0.003), early graft vascular complications (HR=4.01, 95%CI=2.45-6.56; p<0.001) and multiorgan dysfunction syndrome (HR=18.09, 95%CI=10.70-30.58; p<0.001) to be independent predictors of mortality. There were no differences in early mortality related to transplant indication (adjusted HR=1.60, 95%CI=0.93-2.76; p=0.086).ConclusionsThe crude early postoperative mortality rate in non-HCC-LTR was higher than in HCC-LTR, due to a greater incidence of postoperative complications with an impact upon mortality (shock at admission to intensive care and the development of multiorgan dysfunction syndrome).Copyright © 2020 Elsevier España, S.L.U. y SEMICYUC. All rights reserved.

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