J Korean Soc Transplant.  2014 Dec;28(4):226-235. 10.4285/jkstn.2014.28.4.226.

Pre-transplant Predictors for 3-Month Mortality after Living Donor Liver Transplantation

• Lee N
• Kim JM
• Kwon CH
• Joh JW
• Sinn DH
• Lee JH
• Gwak MS
• Paik SW
• Lee SK

• KMID: 1941318
• DOI: http://doi.org/10.4285/jkstn.2014.28.4.226

Abstract

BACKGROUND
High model for end-stage liver disease (MELD) scores (> or =35) is closely associated with poor posttransplantation outcomes in patients who undergo living donor liver transplantation (LDLT). There is little information regarding factors that negatively impact the survival of patients with high MELD scores. The aim of this study was to identify factors associated with 3-month mortality of patients after LDLT.
METHODS
We retrospectively analyzed 774 patients who underwent adult LDLT with right lobe grafts between 1996 and 2012. Exclusion criteria were re-transplantation, left graft, auxiliary partial orthotopic liver transplantation, and inadequate medical recording. Preoperative variables were analyzed retrospectively.
RESULTS
The overall 3-month survival rate was 92%. In univariate analysis, acute progression of disease, severity of hepatic encephalopathy, Child-Pugh class C, hepatorenal syndrome, use of continuous renal replacement therapy, use of ventilator, intensive care unit (ICU) care before transplantation, and MELD scores > or =35 were identified as potential risk factors. However, only ICU care before transplantation and MELD scores > or =35 were independent risk factors for 3-month mortality after LDLT. Three-month and 1-year patient survival rates for those with no risk factors were 95.5% and 88.6%, respectively. In contrast, patients with at least one risk factor had 3-month and 1-year patient survival rates of 88.4% and 81.1%, respectively, while patients with two risk factors had 3-month and 1-year patient survival rates of 55.6% and 55.6%, respectively.
CONCLUSIONS
Patients with both risk factors (ICU care before LDLT and MELD scores > or =35) should be cautiously considered for treatment with LDLT.

Keyword

Living donor liver transplantation; End stage liver disease; Model for end stage liver disease; Pretransplant; Mortality

MeSH Terms

Adult
End Stage Liver Disease
Hepatic Encephalopathy
Hepatorenal Syndrome
Humans
Intensive Care Units
Liver Diseases
Liver Transplantation*
Living Donors*
Medical Records
Mortality*
Renal Replacement Therapy
Retrospective Studies
Risk Factors
Survival Rate
Transplants
Ventilators, Mechanical

Figure

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  Fig. 1. (A) End-stage liver disease (MELD) scores and (B) patients with pretransplant intensive care unit (ICU) care on patient survival.

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  Fig. 2. Patient survival with two risk factors which were high End-stage liver disease score (≥35) and pretransplant intensive care unit care when compared with those who had at least one risk factor or no risk factor.

Reference

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