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Preoperative and Intraoperative Predictors of Postoperative Morbidity, Poor Graft Function, and Early Rejection in 190 Patients Undergoing Liver Transplantation
Elliott Bennett-Guerrero, MD;
Dennis E. Feierman, MD,PhD;
G. Robin Barclay, PhD;
Michael K. Parides, PhD;
Patricia A. Sheiner, MD;
Michael G. Mythen, MD;
Daniel M. Levine, PhD;
Thomas S. Parker, PhD;
Stephen F. Carroll, PhD;
Mark L. White, BA;
Wanda J. Winfree, BSN
Arch Surg. 2001;136:1177-1183.
Hypothesis Preoperative and intraoperative variables predict in part adverse outcome after liver transplantation.
Design Prospective, blinded, cohort study.
Setting Tertiary care hospital.
Subjects A total of 190 adult patients undergoing primary liver transplantation.
Main Outcome Measure Adverse outcome was prospectively defined as either in-hospital death or prolonged postoperative hospitalization (>14 days) associated with morbidity. Potential preoperative and intraoperative risk factors were collected. Associations were tested by univariate analysis followed by multivariate analysis in which preoperative factors were entered before 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 physiological score (P = .002), recipient age (P = .01), preoperative serum high-density lipoprotein cholesterol level (P = .03), preoperative serum creatinine level (P = .002), preoperative serum total IgG level (P = .004), duration in hospital preoperatively (P = .03), operative duration (P<.001), allogeneic erythrocyte transfusions (P<.001), total intraoperative fluids (P = .002), and use of inotropic agents (P = .01). In the final multivariate model, predictors of adverse outcome were United Network for Organ Sharing status (P = .03), recipient age (P = .002), and total intraoperative fluids (P = .04). Most patients who died or had a prolonged hospitalization exhibited dysfunction of more than 1 organ system, including pulmonary, renal, and infectious complications.
Conclusions Adverse outcome occurs frequently after liver transplantation, usually involves multiple organ systems, and is predicted in part by several preoperative and intraoperative factors.
From the Departments of Anesthesiology (Drs Bennett-Guerrero and Feierman and Ms Winfree) and Surgery (Dr Sheiner), Mount Sinai School of Medicine, New York, NY; Department of Medical Microbiology, University of Edinburgh Medical School, Edinburgh, Scotland (Dr Barclay); Department of Biostatistics, Columbia University School of Public Health, New York (Dr Parides); Centre for Anaesthesia, University College London Hospitals, London, England (Dr Mythen); Rogosin Institute, Rockefeller University, New York (Drs Levine and Parker); and XOMA (US) LLC, Berkeley, Calif (Dr Carroll and Mr White). Dr Bennett-Guerrero is now with the Department of Anesthesiology, Columbia University College of Physicians & Surgeons.
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