18 EARLY POSTOPERATIVE MORTALITY IN RECIPIENTS FOLLOWING DECEASED DONOR LIVER TRANSPLANTATION (DDLT)-A CLINICAL PROFILE

Abstract

Background: Liver transplant often results in hemodynamic and biochemical changes in the immediate postoperative period, often causing more concern. Aim: To study the pre-operative clinical profile, and the hematological and biochemical changes in the immediate postoperative period up to 7 days following deceased donor liver transplantation (DDLT) patients. Method: A detailed assessment of the patients’ pre-operative clinical diagnosis, the presence of comorbid illness and postoperative hematological, biochemical, microbiological, and clinical events was made between survivors and those who died. Various parameters were compared between 2 groups to understand the various factors that determined early postoperative outcome in DDLT patients. Result: A total of 26 patients, categorized into Group I – 18 patients (survivors) and Group II – 8 (mortality). There was no difference in the fluctuation of hemoglobin levels between the 2 groups (10% ± 4%). Early leukocytosis and persistent azotemia predicted early morbidity and mortality. A significant fall of platelet count predicted mortality. Transaminases showed a significant rise between the second and third postoperative days, stabilized and then showed downward trends between the seventh and ninth postoperative days in both groups. Hypernatremia predicated early mortality. Cause of death was due to intra-operative events such as cardiac arrhythmias, and due to ischemic cardiac events (2), pulmonary thromboembolism (1), and hepatic artery thrombosis (1), and sepsis and multiorgan failure (4). Two patients required renal replacement therapy for resistant renal failure in Group II. Conclusion: Pre-operative comorbid illness, postoperative worsening azotemia, persistent leukocytosis, and sepsis and cardiac events in the immediate postoperative period predict an outcome post-DDLT. is a very rare among such inherited disorders. Timely intervention and definitive treatment can change the prognosis in this group.