Factors associated with mortality within 24 h of liver transplantation: An updated analysis of 65,308 adult liver transplant recipients between 2002 and 2013

Abstract

Study objectivesIntracardiac and pulmonary thromboembolism (ICPTE), its risk factors and contribution to 24-hour mortality after adult liver transplantation for end-stage liver disease. DesignRetrospective analysis of Standard Transplant Analysis and Research electronic database files. SettingPerioperative. PatientsElectronic files of 65,308 adult liver transplant recipients between 2002 and 2013 obtained from Organ Procurement and Transplantation Network. InterventionsMortality cause analysis and design of a multivariable logistic regression model for predicting the risk of 24-hour mortality due to devastating ICPTE. MeasurementsPerioperative mortality, donor and recipient demographics, donor cause of death, graft ischemic times, etiologies of recipient end-stage liver disease, functional status, comorbidities, and laboratory values. Main results41,324 patients were included. 38,293 (92.6%) survived 30days after transplantation. Postoperative 24-hour mortality was 547 (1.3%) and 2484 (6.0%) within subsequent 30days. Uncontrolled hemorrhage (57 patients, 0.14%), devastating ICPTE (54 patients, 0.13%) and primary graft failure (49 patients, 0.12%) contributed the most and equally to the 24-hour mortality. For the ICPTE, recipients' prior history of pulmonary embolism, portal vein thrombosis, functional status (Karnofsky score) <20, preoperative ventilator support, diabetes mellitus and Asian ethnicity emerged as significant independent hazard factors on multivariable regression analysis. These risk factors were expressed as an index to calculate the overall hazard of a devastating ICPTE; c-statistics 0.70 (p<0.001). ConclusionsDevastating ICPTE contributes significantly to the 24-hour mortality after adult cadaveric liver transplantation. Its most significant risk factors could be expressed as an index with a good predictive accuracy. Further studies of perioperative factors with potential impact on ICPTE and related mortality and morbidity are needed.