Predictors of Mortality in Living Donor Liver Transplantation

• Published in: Transplantation proceedings Vol. 49; no. 6; pp. 1376 - 1382
• Main Authors: Elkholy, S., Mogawer, S., Hosny, A., El-Shazli, M., Al-Jarhi, U.M., Abdel-Hamed, S., Salah, A., El-Garem, N., Sholkamy, A., El-Amir, M., Abdel-Aziz, M.S., Mukhtar, A., El-Sharawy, A., Nabil, A.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.07.2017
• Subjects: Adult; Blood Transfusion - statistics & numerical data; Egypt; End Stage Liver Disease - surgery; Female; Humans; Intensive Care Units; Length of Stay; Liver Transplantation - methods; Liver Transplantation - mortality; Living Donors; Male; Middle Aged; Postoperative Complications - mortality; Regression Analysis; Retrospective Studies; Risk Assessment - methods; Risk Factors; Sepsis - etiology; Sepsis - mortality; Severity of Illness Index; Survival Rate
• ISSN: 0041-1345; 1873-2623
• DOI: 10.1016/j.transproceed.2017.02.055

Egypt has the highest prevalence of the world hepatitis C virus (HCV) load. Hence, the problem of end-stage liver disease (ESLD) is considered a huge burden on the community. Living donor liver transplantation (LDLT) is the only source of donation in Egypt till now. Survival rates had shown significant improvement in the past decades. This study provides analysis of the mortality rates and possible predictors of mortality following LDLT. It also aids in developing a practical and easy-to-apply risk index for prediction of early mortality. This study is a retrospective study that was designed to analyze data from 128 adult patients with ESLD who underwent LDLT in the Liver Transplantation Unit at Faculty of Medicine, Cairo University. Early and late mortality were identified. All potential risk factors were tested using univariate regression for association with early and late mortality. Significant variables were then entered into a multivariable logistic regression model for identifying the predictors for mortality. Sepsis was the most common cause of early mortality. Early mortality and 1-year mortality were 29 (23%) and 23 (18%), respectively. Model for End-Stage Liver Disease (MELD) score, intraoperative packed red blood corpuscles (RBCs), and duration of intensive care unit (ICU) stay were found to be independently associated with early mortality. A MELD score >20, intraoperative transfusion >8 units of packed RBCs, and ICU stay >9 days are three independent predictors of early mortality. Their incorporation into a combined Risk Index can be used to improve outcomes of LDLT. •Sepsis is the most common cause of early mortality after LDLT.•MELD >20, >8 units of RBCs, and ICU stay >9 days are three predictors of mortality.•Their incorporation into a combined index can be used to improve outcomes of LDLT.