Preoperative and intraoperative predictors of postoperative morbidity, poor graft function, and early rejection in 190 patients undergoing liver transplantation

Hypothesis: Preoperative and intraoperative variables predict in part adver se outcome after liver transplantation. Design: Prospective, blinded, cohort study. Setting: Tertiary care hospital. Subjects: A total of 190 adult patients un dergoing primary liver transplantation. Main Outcome Measure: Adverse outcome was prospectively defined as either i n-hospital death or prolonged postoperative hospitalization (> 14 days) ass ociated with morbidity. Potential preoperative and intraoperative risk fact ors were collected. Associations were tested by univariate analysis followe d by multivariate analysis in which preoperative factors were entered befor e intraoperative factors. Results: Adverse outcome occurred in 44.7% of patients. incidences of other complications were as follows: in-hospital mortality (8.4%), primary graft nonfunction (4.2%), poor early graft function (1.1 %), and early rejection (31.2%). Univariate predictors of adverse outcome were United Network for Organ Sharing status (P=.003), Child-Turcotte-Pugh score (P =.02), POSSUM p hysiological score (P =.002), recipient age (P =.01), preoperative serum hi gh-density lipoprotein cholesterol level (P=.03), preoperative serum creati nine level (P=.002), preoperative serum total IgG level (P=.004), duration in hospital preoperatively (P=.03), operative duration (P < .001), allogene ic erythrocyte transfusions (P < .001), total intraoperative fluids (P=.002 ), and use of inotropic agents (P=.01). In the final multivariate model, pr edictors of adverse outcome were United Network for Organ Sharing status (P =.03), recipient age (P=.002), and total intraoperative fluids (P=.04). Mos t patients who died or had a prolonged hospitalization exhibited dysfunctio n of more than 1 organ system, including pulmonary, renal, and infectious c omplications. Conclusions: Adverse outcome occurs frequently after liver transplantation, usually involves multiple organ systems, and is predicted in part by sever al preoperative and intraoperative factors.