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Original Article

J Korean Soc Transplant 2014; 28(4): 226-235

Published online December 31, 2014

https://doi.org//.2014.28.4.226

© The Korean Society for Transplantation

Pre-transplant Predictors for 3-Month Mortality after Living Donor Liver Transplantation

Nuri Lee, M.D.1, Jong Man Kim, M.D.1, Choon Hyuck David Kwon, M.D.1, Jae-Won Joh, M.D.1, Dong Hyun Sinn, M.D.2, Joon Hyeok Lee, M.D.2, Mi Sook Gwak, M.D.3, Seung Woon Paik, M.D.2 and Suk-Koo Lee, M.D.1

Department of Surgery1, Division of Gastroenterology, Department of Medicine2, Department of Anesthesiology and Pain Medicine3, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea

Correspondence to: Jae-Won Joh
Department of Surgery, Samsung Medical Center, Sungkyunkwan
University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul
135-710, Korea
Tel: 82-2-3410-3466, Fax: 82-2-3410-0040
E-mail: jw.joh@samsung.com
First co-author: Nuri Lee, Jong Man Kim

Received: October 24, 2014; Revised: December 8, 2014; Accepted: December 16, 2014

Abstract

Background: High model for end-stage liver disease (MELD) scores (≥35) is closely associated with poor posttransplantation outcomes in patients who undergo living donor liver transplantation (LDLT). There is little information regarding factors that negatively impact the survival of patients with high MELD scores. The aim of this study was to identify factors associated with 3-month mortality of patients after LDLT.
Methods: We retrospectively analyzed 774 patients who underwent adult LDLT with right lobe grafts between 1996 and 2012. Exclusion criteria were re-transplantation, left graft, auxiliary partial orthotopic liver transplantation, and inadequate medical recording. Preoperative variables were analyzed retrospectively.
Results: The overall 3-month survival rate was 92%. In univariate analysis, acute progression of disease, severity of hepatic encephalopathy, Child-Pugh class C, hepatorenal syndrome, use of continuous renal replacement therapy, use of ventilator, intensive care unit (ICU) care before transplantation, and MELD scores ≥35 were identified as potential risk factors. However, only ICU care before transplantation and MELD scores ≥35 were independent risk factors for 3-month mortality after LDLT. Three-month and 1-year patient survival rates for those with no risk factors were 95.5% and 88.6%, respectively. In contrast, patients with at least one risk factor had 3-month and 1-year patient survival rates of 88.4% and 81.1%, respectively, while patients with two risk factors had 3-month and 1-year patient survival rates of 55.6% and 55.6%, respectively.
Conclusions: Patients with both risk factors (ICU care before LDLT and MELD scores ≥35) should be cautiously considered for treatment with LDLT.

Keywords: Living donor liver transplantation, End stage liver disease, Model for end stage liver disease, Pretransplant, Mortality