Factors associated with mortality within 24 h of liver transplantation

An updated analysis of 65,308 adult liver transplant recipients between 2002 and 2013

Kyota Fukazawa, Ernesto Pretto, Seigo Nishida, Jorge D. Reyes, Edward Gologorsky

Research output: Contribution to journalArticle

9 Citations (Scopus)

Abstract

Study objectives Intracardiac and pulmonary thromboembolism (ICPTE), its risk factors and contribution to 24-hour mortality after adult liver transplantation for end-stage liver disease. Design Retrospective analysis of Standard Transplant Analysis and Research electronic database files. Setting Perioperative. Patients Electronic files of 65,308 adult liver transplant recipients between 2002 and 2013 obtained from Organ Procurement and Transplantation Network. Interventions Mortality cause analysis and design of a multivariable logistic regression model for predicting the risk of 24-hour mortality due to devastating ICPTE. Measurements Perioperative mortality, donor and recipient demographics, donor cause of death, graft ischemic times, etiologies of recipient end-stage liver disease, functional status, comorbidities, and laboratory values. Main results 41,324 patients were included. 38,293 (92.6%) survived 30 days after transplantation. Postoperative 24-hour mortality was 547 (1.3%) and 2484 (6.0%) within subsequent 30 days. Uncontrolled hemorrhage (57 patients, 0.14%), devastating ICPTE (54 patients, 0.13%) and primary graft failure (49 patients, 0.12%) contributed the most and equally to the 24-hour mortality. For the ICPTE, recipients' prior history of pulmonary embolism, portal vein thrombosis, functional status (Karnofsky score) < 20, preoperative ventilator support, diabetes mellitus and Asian ethnicity emerged as significant independent hazard factors on multivariable regression analysis. These risk factors were expressed as an index to calculate the overall hazard of a devastating ICPTE; c-statistics 0.70 (p < 0.001). Conclusions Devastating ICPTE contributes significantly to the 24-hour mortality after adult cadaveric liver transplantation. Its most significant risk factors could be expressed as an index with a good predictive accuracy. Further studies of perioperative factors with potential impact on ICPTE and related mortality and morbidity are needed.

Original languageEnglish (US)
Pages (from-to)35-40
Number of pages6
JournalJournal of Clinical Anesthesia
Volume44
DOIs
StatePublished - Jan 1 2018

Fingerprint

Pulmonary Embolism
Liver Transplantation
Mortality
Liver
End Stage Liver Disease
Transplants
Logistic Models
Tissue Donors
Tissue and Organ Procurement
Transplant Recipients
Organ Transplantation
Mechanical Ventilators
Portal Vein
Comorbidity
Cause of Death
Diabetes Mellitus
Thrombosis
Transplantation
Regression Analysis
Demography

Keywords

  • Futile
  • Liver transplant
  • Mortality
  • Pulmonary embolism
  • Risk
  • Transesophageal echocardiography

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine

Cite this

Factors associated with mortality within 24 h of liver transplantation : An updated analysis of 65,308 adult liver transplant recipients between 2002 and 2013. / Fukazawa, Kyota; Pretto, Ernesto; Nishida, Seigo; Reyes, Jorge D.; Gologorsky, Edward.

In: Journal of Clinical Anesthesia, Vol. 44, 01.01.2018, p. 35-40.

Research output: Contribution to journalArticle

Fukazawa, Kyota ; Pretto, Ernesto ; Nishida, Seigo ; Reyes, Jorge D. ; Gologorsky, Edward. / Factors associated with mortality within 24 h of liver transplantation : An updated analysis of 65,308 adult liver transplant recipients between 2002 and 2013. In: Journal of Clinical Anesthesia. 2018 ; Vol. 44. pp. 35-40.
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abstract = "Study objectives Intracardiac and pulmonary thromboembolism (ICPTE), its risk factors and contribution to 24-hour mortality after adult liver transplantation for end-stage liver disease. Design Retrospective analysis of Standard Transplant Analysis and Research electronic database files. Setting Perioperative. Patients Electronic files of 65,308 adult liver transplant recipients between 2002 and 2013 obtained from Organ Procurement and Transplantation Network. Interventions Mortality cause analysis and design of a multivariable logistic regression model for predicting the risk of 24-hour mortality due to devastating ICPTE. Measurements Perioperative mortality, donor and recipient demographics, donor cause of death, graft ischemic times, etiologies of recipient end-stage liver disease, functional status, comorbidities, and laboratory values. Main results 41,324 patients were included. 38,293 (92.6{\%}) survived 30 days after transplantation. Postoperative 24-hour mortality was 547 (1.3{\%}) and 2484 (6.0{\%}) within subsequent 30 days. Uncontrolled hemorrhage (57 patients, 0.14{\%}), devastating ICPTE (54 patients, 0.13{\%}) and primary graft failure (49 patients, 0.12{\%}) contributed the most and equally to the 24-hour mortality. For the ICPTE, recipients' prior history of pulmonary embolism, portal vein thrombosis, functional status (Karnofsky score) < 20, preoperative ventilator support, diabetes mellitus and Asian ethnicity emerged as significant independent hazard factors on multivariable regression analysis. These risk factors were expressed as an index to calculate the overall hazard of a devastating ICPTE; c-statistics 0.70 (p < 0.001). Conclusions Devastating ICPTE contributes significantly to the 24-hour mortality after adult cadaveric liver transplantation. Its most significant risk factors could be expressed as an index with a good predictive accuracy. Further studies of perioperative factors with potential impact on ICPTE and related mortality and morbidity are needed.",
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T2 - An updated analysis of 65,308 adult liver transplant recipients between 2002 and 2013

AU - Fukazawa, Kyota

AU - Pretto, Ernesto

AU - Nishida, Seigo

AU - Reyes, Jorge D.

AU - Gologorsky, Edward

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N2 - Study objectives Intracardiac and pulmonary thromboembolism (ICPTE), its risk factors and contribution to 24-hour mortality after adult liver transplantation for end-stage liver disease. Design Retrospective analysis of Standard Transplant Analysis and Research electronic database files. Setting Perioperative. Patients Electronic files of 65,308 adult liver transplant recipients between 2002 and 2013 obtained from Organ Procurement and Transplantation Network. Interventions Mortality cause analysis and design of a multivariable logistic regression model for predicting the risk of 24-hour mortality due to devastating ICPTE. Measurements Perioperative mortality, donor and recipient demographics, donor cause of death, graft ischemic times, etiologies of recipient end-stage liver disease, functional status, comorbidities, and laboratory values. Main results 41,324 patients were included. 38,293 (92.6%) survived 30 days after transplantation. Postoperative 24-hour mortality was 547 (1.3%) and 2484 (6.0%) within subsequent 30 days. Uncontrolled hemorrhage (57 patients, 0.14%), devastating ICPTE (54 patients, 0.13%) and primary graft failure (49 patients, 0.12%) contributed the most and equally to the 24-hour mortality. For the ICPTE, recipients' prior history of pulmonary embolism, portal vein thrombosis, functional status (Karnofsky score) < 20, preoperative ventilator support, diabetes mellitus and Asian ethnicity emerged as significant independent hazard factors on multivariable regression analysis. These risk factors were expressed as an index to calculate the overall hazard of a devastating ICPTE; c-statistics 0.70 (p < 0.001). Conclusions Devastating ICPTE contributes significantly to the 24-hour mortality after adult cadaveric liver transplantation. Its most significant risk factors could be expressed as an index with a good predictive accuracy. Further studies of perioperative factors with potential impact on ICPTE and related mortality and morbidity are needed.

AB - Study objectives Intracardiac and pulmonary thromboembolism (ICPTE), its risk factors and contribution to 24-hour mortality after adult liver transplantation for end-stage liver disease. Design Retrospective analysis of Standard Transplant Analysis and Research electronic database files. Setting Perioperative. Patients Electronic files of 65,308 adult liver transplant recipients between 2002 and 2013 obtained from Organ Procurement and Transplantation Network. Interventions Mortality cause analysis and design of a multivariable logistic regression model for predicting the risk of 24-hour mortality due to devastating ICPTE. Measurements Perioperative mortality, donor and recipient demographics, donor cause of death, graft ischemic times, etiologies of recipient end-stage liver disease, functional status, comorbidities, and laboratory values. Main results 41,324 patients were included. 38,293 (92.6%) survived 30 days after transplantation. Postoperative 24-hour mortality was 547 (1.3%) and 2484 (6.0%) within subsequent 30 days. Uncontrolled hemorrhage (57 patients, 0.14%), devastating ICPTE (54 patients, 0.13%) and primary graft failure (49 patients, 0.12%) contributed the most and equally to the 24-hour mortality. For the ICPTE, recipients' prior history of pulmonary embolism, portal vein thrombosis, functional status (Karnofsky score) < 20, preoperative ventilator support, diabetes mellitus and Asian ethnicity emerged as significant independent hazard factors on multivariable regression analysis. These risk factors were expressed as an index to calculate the overall hazard of a devastating ICPTE; c-statistics 0.70 (p < 0.001). Conclusions Devastating ICPTE contributes significantly to the 24-hour mortality after adult cadaveric liver transplantation. Its most significant risk factors could be expressed as an index with a good predictive accuracy. Further studies of perioperative factors with potential impact on ICPTE and related mortality and morbidity are needed.

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KW - Mortality

KW - Pulmonary embolism

KW - Risk

KW - Transesophageal echocardiography

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