Morbidity of liver transplantation in patients with multiorgan failure in the intensive care unit

Abstract

Background: The mean MELD-Na at the time of liver transplant (LT) varies widely across the 11 regions in the United States (US), due to organ supply versus demand issues, from 22 to as high as 35. Utilizing marginal donors on very sick patients has become more commonplace in some regions of the US but it has not been determined as to which patients are “too sick” to undergo LT. The purpose of our study was to determine if the use of Methods: A retrospective review comparing LT in patients from home (n = 40) to patients from the ICU (n = 44) between 2009–2016 with a MELD-Na >25. Preoperative variables included: demographics, etiologies, MELD-Na, and ICU risk factors (mechanical ventilation, vasopressors, hemodialysis, blood transfusions, length of stay (LOS)). Intraoperative variables included: transfusions, organ ischemia, donor risk index, operative time, and complications. Postoperative outcomes included: LOS, mechanical ventilation, re-operation, biliary complications, infection, short and long term renal dysfunction, 30-day readmission, liver biopsy, graft and patient 1 year survival. Results: We found that in in patients who underwent LT from the ICU versus those from home: median MELD-Na 43 vs 36 (p < 0.05), 1 year graft survival of 86.7% vs 90% (p = 0.74), 1 year patient survival of 86.7% vs 92.5% (p = 0.49). Conclusion: LT in the ICU patient continues to face challenges, especially when considering the severe organ shortage in the US. We found that in carefully selected ICU patients, even with multiorgan dysfunction, 1 year graft and patient survival are similar to outpatients.