Preoperation risk factor analysis in orthotopic liver transplantation with pretransplant artificial liver support therapy

The early mortality after orthotopic liver transplantation (OLT) remains relatively high. We evaluate the pretransplantation Molecular Adsorbents Recirculating System (MARS) therapy in reducing the relevant risk factors relating to this early mortality.

Methods

Fifty adult patients undergoing OLT with MARS preoperation therapy were studied, 28 men and 22 women with a mean age of 52.24 (range 46–68) years.

Results

Eighty treatments were performed safely. All patients showed a positive response: the SOFA score, Glasgow Coma Score (GCS), mean arterial pressure (MAP), TNF-α and IL-10 were improved significantly (Table 1). Eight patients recovered and avoided OLT, eight patients died, 34 patients were successfully bridged to OLT: the OLT outcome within 30 days was 28 kept alive and six patients died. The stepwise logistic regression indicated the reversible factors that had independent associations with early mortality were creatinine, International Normalised Ratio (INR), SOFA score, TNF-α and IL-10, with regression coefficients of 0.315, 0.309, 0.224, 0.192 and 0.188, respectively.

Table 1

We think preoperation SOFA score, creatinine, INR, TNF-α and IL-10 are the main OLT preoperative reversible risk factors, MARS treatment before OLT can relieve these factors significantly, hence improving the survival rate of OLT or even avoiding transplantation.