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Independent Factors Predicting Postoperative 30-Day Mortality in 101 Infants Following Liver Transplantation
Chan Woo Cho1, Sanghoon Lee1, Jong Man Kim1
1Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
Insights
Infant liver transplantation (LT) has risk factors for 30-day mortality. Independent predictors include intensive care unit stay before LT, reoperation, and high graft-to-recipient weight ratio (GRWR), indicating graft size mismatch impacts outcomes.
Area of Science:
- Pediatric Surgery
- Transplantation Medicine
- Critical Care Medicine
Background:
- Infant liver transplantation (LT) presents significant surgical challenges.
- Identifying factors influencing short-term survival is crucial for improving outcomes in pediatric LT recipients.
Purpose of the Study:
- To determine the risk factors associated with 30-day mortality in infants undergoing liver transplantation.
- To analyze the relationship between patient characteristics, perioperative conditions, and early mortality after infant LT.
Main Methods:
- A retrospective study of 101 infant LT recipients from May 1997 to March 2015.
- Patients were categorized into deceased (n=9) and live (n=92) groups based on 30-day mortality.
- Multivariate analysis using binary logistic regression identified independent predictors of mortality.
Main Results:
- Significant differences were observed in height, weight, preoperative bilirubin, creatinine clearance, primary diagnosis, and graft-to-recipient weight ratio (GRWR) between survivors and non-survivors.
- Independent predictors of 30-day mortality included preoperative intensive care unit (ICU) hospitalization, reoperation within 30 days, and a high GRWR (>4).
Conclusions:
- Postoperative mortality in infant LT is correlated with recipient preoperative/postoperative status and graft size mismatch.
- A high GRWR, indicating a relatively large graft, is associated with increased risk of graft failure or primary nonfunction in infant recipients.
Abstract:
BACKGROUND Liver transplantation (LT) in infants is a challenging procedure. This study was designed to identify risk factors of 30-day mortality of infant LT recipients. MATERIAL AND METHODS A total of 101 infants treated between May 1997 and March 2015 were assigned to one of two groups, a deceased infant group (n=9) or a live infant group (n=92), according to their mortality status at 30 days after LT. RESULTS Patient characteristics of height, weight, preoperative total bilirubin, creatinine clearance, primary diagnosis, and graft-to-recipient weight ratio (GRWR) were significantly different between the two groups. In a binary logistic regression model for multivariate analysis, independent predictors of postoperative mortality in infants after LT were hospitalization in the intensive care unit before LT, reoperation within 30 days of the first operation, and high GRWR (>4). CONCLUSIONS Postoperative mortality of infants following LT showed significant correlations with recipient preoperative and postoperative conditions and also with graft size mismatch. Regarding GRWR, our data indicated that relatively large grafts given to infant recipients often lead to graft failure or primary nonfunction during the postoperative stage.
