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

Abstract

Background: High model for end-stage liver disease (MELD) scores (≥35) is closely associated with poor posttransplantation out- comes 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 mortal- ity 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 ence- phalopathy, 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 ≥35 were identified as potential risk factors. However, only ICU care before transplantation and MELD scores ≥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 ≥35) should be cautiously considered for treatment with LDLT.