Predictive factors of mortality in liver transplantation

Introduction

The inclusion criteria for liver transplantation are wider every time and that makes the waiting list longer and longer; on the contrary, the organs from the donor subjects are limited. That is why it is so important to select the candidates and to know the predictive factors for success.

Materials and methods

We studied 102 patients that had received an orthopic liver transplant (OLT) from a donor subject during the past 5 years. We studied the mortality during the 6-month period post-transplantation. We analyzed variables of the donor: age, gender, cold ischemic time and cause of death. We evaluated the number of blood concentrates transfused during surgery, age, gender, serology of the receptor, reason for transplantation, stage according to the Child-Pugh classification and biochemistry parameters of liver and renal function in the pre-transplantation and immediate post-transplantation period. We made a descriptive study and a statistical study, univariable and multivariable, using Student's t test and the chi-quadrate.

Results

We present 102 patients that had received an OLT, 67.6% male and 32.4% female. The mean age of the receptors was 52.58 years, and of the donors was 52.08 years. The most frequent cause of brain death of the donor subject was due to CVA (58.9%). The aetiology of liver failure was 50% due to alcoholic cirrhosis, 20.6% due to HCV, 3.9% due to fulminate failure and 6.9% due to hepatocelullar carcinoma. According to the Child-Pugh classification, 13.7% was in stage A, 43.1% in stage B and 33.3% in stage C. The HCV-positive percentage was 22.5%, and 13.7% was diagnosed with diabetes mellitus pre transplantation, 6.9% suffered from ischemic heart disease and 18.6% presented a hepatorenal syndrome. During the immediate postsurgery period, 51% presented renal dysfunction.

We identified the following as prognostic factors of mortality: renal dysfunction in the immediate postsurgery period (P = 0.001), cause of death of the donor (P = 0.049) and aetiology of liver failure (P = 0.028), with fulminant hepatic failure as the worse predictive factor, followed by cirrhosis due to HCV. Also, the parameters of liver function at the moment of admittance to the ICU: ASAT (P = 0.006), ALAT (P = 0.002), albumin (P = 0.047), and total proteins (P = 0.039).

Conclusion

The hepatic and renal dysfunction at the moment of admittance to the ICU are good predictors of mortality. Other factors such as cause of brain death of the donor and the aetiology of the liver disease are also to be taken into account in the initial valuation and evaluation of the receptor.