Predictors of early recipient mortality after living donor liver transplantation in a tertiary care center in Egypt.

Background: Living donor liver transplantation (LDLT) has evolved into a widely accepted therapeutic option. Many different risk factors may affect early mortality after LDLT.

Objectives: Analyze risk factors that can affect early (<6 months) mortality of patients after LDLT in a single center.

Design: Retrospective chart review of patients who underwent LDLT.

Setting: University hospital.

Patients And Methods: Adult cirrhotic patients who underwent LDLT were classified by early (first 6 months) or late mortality. A full pre, intra- and post-operative evaluation had been done on all patients including a full history, examination and investigations to identify risk factors that might affect mortality post-LDLT.

Main Outcome Measures: Determination of pre-, intra- or postoperative factors that might affect recipient mortality post-LDLT.

Sample Size: 123.

Results: Pre-operative factors that increased early mortality in a univariate analysis were higher model for end-stage liver disease (MELD) scores, lower graft-recipient weigh ratio (GRWR), older donor age, and recurrent spontaneous bacterial peritonitis. Intraoperative factors included more transfusion units of blood, plasma, platelets and cryoprecipitate, a longer time for cold and warm ischemia, and a longer anhepatic phase among others. Postoperative factors included a longer ICU or hospital stay and abnormal postoperative laboratory data. In the final logistic regression model, the most significant factors were pre-operative GRWR, length of hospital stay, units of intraoperative blood transfusion, postoperative alanine aminotransferase, postoperative total leukocyte count, and MELD score.

Conclusion: LDLT outcomes might be improved by attempting to resolve clinical factors that have been identified as contributors to early post-LDLT mortality.

Limitations: More risk factors, such as those relevant to patient portal vein hemodynamics, should be included in an analysis of predictors of early mortality.

Conflict Of Interest: None.