Risk Factors of Mortality After Liver Transplantation in Uruguay

• Published in: Transplantation proceedings Vol. 50; no. 2; pp. 499 - 502
• Main Authors: Olivari, D., Mainardi, V., Rando, K., Rey, G., Menendez, J., Prieto, J., Medina, J., Valverde, M., Castelli, J., Grecco, G., Leites, A., Zunini, G., Gozalez, S., Harguindeguy, M., Gerona, S.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-03-2018
• ISSN: 0041-1345; 1873-2623
• DOI: 10.1016/j.transproceed.2017.12.036

Identification of predictive factors of mortality in a liver transplant (LT) program optimizes patient selection and allocation of organs.
To determine survival rates and predictive factors of mortality after LT in the National Liver Transplant Program of Uruguay.
A retrospective study was conducted analyzing data prospectively collected into a multidisciplinary database. All patients transplanted since the beginning of the program on July 2009 to April 2017 were included (n = 148). Twenty-nine factors were analyzed through the univariate Kaplan-Meier model. A Cox regression model was used in the multivariate analysis to identify the independent prognostic factors for survival.
Overall survival was 92%, 87%, and 78% at discharge, 1 year, and 3 years, respectively. The Kaplan-Meier survival curves were significantly lower in: recipients aged >60 years, Model for End-Stage Liver Disease score >21, LT due to hepatocellular carcinoma (HCC) and acute liver failure (ALF), donors with comorbidities, intraoperative blood loss beyond the median (>2350 mL), red blood cell transfusion requirement beyond the median (>1254 mL), intraoperative complications, delay of extubation, invasive bacterial, and fungal infection after LT and stay in critical care unit >4 days. The Cox regression model (likelihood ratio test, P = 1.976 e−06) identified the following independent prognostic factors for survival: LT for HCC (hazard ratio [HR] 4.511; P = .001) and ALF (HR 6.346; P = .004), donors with comorbidities (HR 2.354; P = .041), intraoperative complications (HR 2.707; P = .027), and invasive fungal infections (HR 3.281; P = .025).
The survival rates of LT patients as well as the mortality-associated factors are similar to those reported in the international literature.