In-hospital mortality of liver transplantation and risk factors: a single-center experience

Abstract

Background: Liver transplantation (LT) is a life-saving treatment for patients with end-stage liver disease and acute liver failure. However, in-hospital death cannot be avoided. We designed this study to analyze patients' in-hospital mortality rate after LT and the factors correlated with in-hospital death.Methods: The data of patients who received LT in our hospital between January 11, 2015, and November 19, 2019, were obtained from the China Liver Transplant Registry and medical records. The in-hospital mortality rate was calculated, and factors related to mortality, cause of death, and factors related to cause of death were analyzed by reviewing patients' data.Results: A total of 529 patients who underwent cadaveric LT were enrolled in this study. Modified piggyback orthotopic LT was performed for all patients. Seventy patients died in the hospital after LT, and the in-hospital mortality rate was 13.2%. Factors including model for end-stage liver disease (MELD) score, Child-Pugh grading, intraoperative blood loss, and anhepatic phase were correlated with in-hospital death. MELD score and intraoperative blood loss were determined as the two independent risk factors of in-hospital death. The first two causes of death were infection (34.3%) and primary non-function (15.7%).Pulmonary fungal infection was the main cause of infectious death. MELD score was the independent risk factor for infectious death, and both body mass index of donors and cold ischemic time were independent risk factors of primary non-function.Conclusions: In-hospital death poses a threat to certain patients undergoing LT. Our study suggests that the main cause of in-hospital death is an infection, followed by primary non-function.

Invasive Fungal Infections: The Early Killer after Liver Transplantation

“…Liver transplantation is a potentially life-saving treatment for end-stage liver disease and certain malignancies. Throughout the last decades long-term outcomes have markedly improved, but in-hospital mortality for deceased liver donations is still high (10%) [14][15][16]. Studies examining the causes and course of early postoperative death are sparse, Age, male sex, BMI, underlying disease, MELD-score, intraoperative blood loss, and co-morbidity expressed by the Charlson Comorbidity Index were not associated with an elevated risk for early postoperative mortality.…”

“…Liver transplantation is a potentially life-saving treatment for end-stage liver disease and certain malignancies. Throughout the last decades long-term outcomes have markedly improved, but in-hospital mortality for deceased liver donations is still high (10%) [ 14 , 15 , 16 ]. Studies examining the causes and course of early postoperative death are sparse, although this is the most critical period after the OLT [ 11 , 19 , 30 , 31 ].…”

“…Although long-term outcomes have greatly improved over time, the early postoperative period remains critical. Previously published overall in-hospital mortality rates vary between 6.3% and 8.4%, and can be up to 13.6% for deceased-donor liver transplantation [ 14 , 15 , 16 ]. The European Liver Transplant Registry reported that 46% of deaths and 65% of re-transplantations occur within the first half year after OLT, with almost 50% of graft failures and one quarter of deaths occurring within the first month [ 11 ].…”

“…have been the main determinants of short-term mortality. However, little is known about the early postoperative mortality or the role of fungal infections in the current era [ 16 , 17 , 18 , 19 ].…”

Diagnostic Value and Clinical Application of mNGS for Post-Liver Transplantation Infection: A Cross-Sectional Study With Case Reports

“…Since Prof. Starzl performed the first liver transplantation operation in human history in 1963, the expertise for liver transplantation has spread globally (Vonkaulla, 1963 ). Nowadays, LT has become a routine operation associated with a 1-year survival rate of 82% in the European Liver Transplant Registry and 87% in the Japanese registry, and a 10-year survival rate ranging from 53 to 76% in the American, European, and Japanese registries (Zhang et al, 2021 ). With refined liver transplantation techniques and the standardization of perioperative management, the postoperative survival rate of LT recipients in China has gradually increased.…”