Intraoperative Predictors of Short-Term Mortality in Living Donor Liver Transplantation Due to Acute Liver Failure

Background. Acute liver failure (ALP) is a rare and fatal disease with rapidly deteriorating clinical features. Many predictive models for ALP outcomes have been tested, but none have been adopted as definitive guidelines for prognosis because of inconsistencies in accuracy. Most prognostic models for ALF are based on preoperative patient conditions, thus ignoring various specific intraoperative features relevant to postoperative outcomes. We investigated whether intraoperative factors predicted short-term mortality due to ALF in living donor liver transplantations (LDLT). Methods. We retrospectively collected intraoperative data, including surgical time, fluctuations in mean blood pressure (MBP) and heart rate, mean pulmonary arterial pressure (PAP), central venous pressure (CVP), urine output, laboratory data, oxygen indices (PaO2/FiO(2)), administered drugs, and transfusion of packed red blood cells (PRBCs) from 101 patients with ALP who underwent LDLT. After simple relationships of individual intraoperative variables with 1-month posttransplant mortality were analyzed, we examined potentially significant intraoperative variables (P < .10) by a multivariate adjustment process with preoperative indicators of ALP prognosis. Results. Intraoperative MBP fluctuations, first mean PAP and CVP, last oxygen index, administered calcium chloride, and PRBC transfusion showed individual associations with posttransplant mortality of ALF patients (P < .05). After multivariate adjustment, PRBC transfusion of >= 10 pints (odds ratio 4.73; 95% confidence interval [CI] 1.06-21.16) and MBP fluctuations (odds ratio 1.26; 95% CI 1.00-1.58) were identified to be independent predictors of 1-month posttransplant mortality, together with preoperative factors, including severe hepatic encephalopathy, and a Model for End-stage Liver Disease score >= 30 points (area under the curve 0.82, P < .001). Conclusion. MBP fluctuations and large blood transfusions were intraoperative predictors of short-term mortality after LDLT due to ALP. Increased attention to intraoperative manifestations should provide valuable prognostic information for ALF.