Retrospective Analysis of Risk Factors and Surgical Outcomes in Liver Transplant Recipients

BACKGROUND Liver transplantation (LT) is the definitive treatment for selected patients with end-stage liver disease (ESLD), yet postoperative complications remain a major challenge, particularly in regions where living donor liver transplantation (LDLT) predominates. This study aimed to evaluate surgical outcomes, identify predictors of early mortality, and assess the incidence and impact of biliary complications in a low-volume transplant center in Central Asia. MATERIAL AND METHODS We retrospectively analyzed 113 liver transplantations performed at the National Research Oncology Center between 2013 and 2025. The cohort comprised 88 LDLT (77.9%) and 25 deceased donor LT (DDLT) cases, with a mean recipient age of 43.8 years. RESULTS The overall 1-, 3-, 5-, 7-, and 10-year survival rates were 76.3%, 72.9%, 70.0%, 70.0%, and 70.0%, respectively, with no significant difference between LDLT and DDLT. Biliary leakage (BL) and biliary stricture (BS) occurred in 26.5% and 20% of recipients, respectively. Graft steatosis and external bile duct (EBD) stenting were independent predictors of BL, while intraoperative bleeding and EBD predicted BS. Hepatic artery thrombosis (HAT) occurred in 14.1% of patients and was a significant predictor of 90-day mortality. Sepsis was the strongest predictor of 30-day (OR 7.92, P=0.022) and 90-day mortality (OR 20.1, P CONCLUSIONS Biliary complications remain common, particularly in LDLT, and are influenced by graft and reconstruction factors. Advances in surgical technique, infection control, and early recognition of vascular complication remain decisive for optimizing outcomes after liver transplantation.