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 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.