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Vol. 45. Issue 7.
Pages 395-410 (October 2021)
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Vol. 45. Issue 7.
Pages 395-410 (October 2021)
Original
DOI: 10.1016/j.medine.2020.02.004
Early postoperative mortality in liver transplant recipients involving indications other than hepatocellular carcinoma. A retrospective cohort study
Mortalidad postoperatoria precoz en los receptores de trasplante hepático por indicaciones distintas al carcinoma hepatocelular (non-HCC). Estudio retrospectivo de cohortes
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J.C. Pozo-Laderasa,
Corresponding author
drjcpozo@hotmail.com

Corresponding author.
, I. Gulerb, M. Rodríguez-Perálvarezc, J.C. Roblesa, A. Mulaa, P. López-Cillerod, C. de la Fuentea
a Intensive Care Medicine, Reina Sofia University Hospital and Maimonides Biomedical Research Institute (IMIBIC), Cordoba, Spain
b Methodology and Biostatistics, IMIBIC, Cordoba, Spain
c Hepatology, Reina Sofia University Hospital and IMIBIC, Cordoba, Spain
d Surgery and Liver Transplantation, Reina Sofia University Hospital and IMIBIC, Cordoba, Spain
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Tables (5)
Table 1. Baseline characteristics of liver transplant recipients. Comparison of risk between cohorts (non-HCC-LTR vs HCC-LTR) by binary logistic regression.
Table 2. Donors characteristics and transplantation surgical time features. Comparison of risk between cohorts (non-HCC-LTR vs HCC-LTR) by binary logistic regression.
Table 3. Postoperative features in liver transplant recipients cohort.
Table 4. Univariate and multivariate analysis of liver transplant recipients mortality endpoint using Cox's proportional hazards model.
Table 5. Mortality rates of overall and indication related cohorts by time sequences during early postoperative period.
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Additional material (1)
Abstract
Aims

To analyze the perioperative differences in a consecutive cohort of liver transplant recipients (LTRs) classified according to the indication of transplantation, and assess their impact upon early mortality 90 days after transplantation.

Design

A retrospective cohort study was carried out.

Scope

A single university hospital.

Patients

A total of 892 consecutive adult LTRs were included from January 1995 to December 2017. Recipients with acute liver failure, retransplantation or with grafts from non-brain death donors were excluded. Two cohorts were analyzed according to transplant indication: hepatocellular carcinoma (HCC-LTR) versus non-carcinoma (non-HCC-LTR).

Main variables of interest

Recipient early mortality was the primary endpoint. The pretransplant recipient and donor characteristics, surgical time data and postoperative complications were analyzed as independent predictors.

Results

The crude early postoperative mortality rate related to transplant indication was 13.3% in non-HCC-LTR and 6.6% in HCC-LTR (non-adjusted HR=2.12, 95%CI=1.25–3.60; p=0.005). Comparison of the perioperative features between the cohorts revealed multiple differences. Multivariate analysis showed postoperative shock (HR=2.02, 95%CI=1.26–3.24; p=0.003), early graft vascular complications (HR=4.01, 95%CI=2.45–6.56; p<0.001) and multiorgan dysfunction syndrome (HR=18.09, 95%CI=10.70–30.58; p<0.001) to be independent predictors of mortality. There were no differences in early mortality related to transplant indication (adjusted HR=1.60, 95%CI=0.93–2.76; p=0.086).

Conclusions

The crude early postoperative mortality rate in non-HCC-LTR was higher than in HCC-LTR, due to a greater incidence of postoperative complications with an impact upon mortality (shock at admission to intensive care and the development of multiorgan dysfunction syndrome).

Keywords:
Liver transplantation
Hepatocellular carcinoma
Postoperative complications
Mortality
Cox regression analysis
Resumen
Objetivos

Analizar las diferencias perioperatorias de una cohorte de trasplantados hepáticos (LTR) clasificados por la indicación de trasplante, y evaluar su impacto sobre la mortalidad precoz (90 días postrasplante).

Diseño

Estudio de cohorte retrospectivo.

Ámbito

Institución universitaria.

Pacientes

Desde 1995 hasta 2017 fueron incluidos 892 LTR. Se excluyeron los receptores con fallo hepático agudo, retrasplante o de donantes sin muerte cerebral. Se analizaron 2 cohortes según el motivo del trasplante: carcinoma hepatocelular (HCC-LTR) vs. causas diferente al carcinoma (non-HCC-LTR).

Principales variables de interés

La variable principal fue la mortalidad precoz. Las características pretrasplante de receptores, donantes, tiempo quirúrgico y complicaciones postoperatorias se estudiaron como predictores independientes.

Resultados

La mortalidad postoperatoria temprana bruta relacionada con la indicación de trasplante fue del 13,3% en non-HCC-LTR y del 6,6% en HCC-LTR (HR no ajustada: 2,12; IC 95%: 1,25-3,60; p=0,005). La comparación de características perioperatorias entre las cohortes mostró múltiples diferencias. El shock postoperatorio (HR: 2,02; IC 95%: 1,26-3,24), complicaciones vasculares tempranas del injerto (HR: 4,01; IC 95%: 2,45-6,56) y síndrome de disfunción multiorgánica (HR: 18,09; IC 95%: 10,70-30,58) fueron predictores independientes de mortalidad. La indicación de trasplante no mostró significación en el análisis multivariante (HR ajustada: 1,60; IC 95%: 0,93-2,76; p=0,086).

Conclusiones

La mortalidad postoperatoria temprana bruta en non-HCC-LTR fue mayor que en HCC-LTR debido a la mayor incidencia de complicaciones postoperatorias con impacto en la mortalidad (shock al ingreso en la UCI y aparición del síndrome de disfunción multiorgánica).

Palabras clave:
Trasplante de hígado
Carcinoma hepatocelular
Complicaciones postoperatorias
Mortalidad
Regresión de Cox

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