Outcome of patients submitted to orthotopic liver transplantation in a private clinic
© BioMed Central Ltd 2007
Published: 19 June 2007
Orthotopic liver transplantation (OLT) is one of the most complex surgical procedures, due to hepatic dysfunction, immunosuppression, and multiple anastomosis. Several complications are possible, making it necessary to provide an immediate, specialized, postoperatory intensive care treatment.
To study the intrahospital evolution of patients submitted to OLT.
A retrospective study of OLT patients from 1997 to 2007, in a private clinic of Rio de Janeiro. We collected data from comorbidities, characteristics of surgery, blood transfusions, sepsis, graft rejection, multiple organ dysfunction, APACHE II, SOFA and MELD scores, ICU and hospital length of stay, and outcome.
Thirty-one patients were studied; the mean (± SD) age was 49 ± 11 years; 16 male/15 female. The mean (± SD) collected scores were: MELD = 17 ± 6.7 points, SOFA = 4.3 ± 2.8 points, and APACHE II = 14.5 ± 6.2 points. The hepatic disease was: cirrhosis (77.4%), amyloidosis (6.5%), hepatitis C (54.8%), hepatitis B (6.5%), and hepatocellular carcinoma (9.7%). The main complications were: biliary fistulas (9.7%), hepatic artery thrombosis (12.9%), acute rejection (25.8%), pneumonia (29%), and acute renal failure (61.3%). Twelve patients (38.7%) were resubmitted to surgery, one of them for a retransplant. Collected scores were higher (mean ± SD) in deceased patients: MELD score - alive = 15.8 ± 5.1 points vs death = 22 ± 10.3 points, P = 0.04; SOFA score - alive = 3.75 ± 1.8 points vs death = 6.5 ± 3.8 points, P = 0.03; and APACHE II score - alive = 13.1 ± 4.8 points vs death = 20.3 ± 8.3 points, P = 0.008. The mean (± SD) ICU and hospitalization lengths of stay were 8.2 ± 6.3 days and 18.5 ± 8.3 days, respectively. The hospital mortality rate was 19.4%.
The characteristics of our OLT patients were comparable with other published series. The MELD, SOFA and APACHE II scores were more elevated in deceased patients.