Preoperative hepatic encephalopathy predicts early postoperative complications after orthotopic liver transplantation: a retrospective cohort study

Early postoperative complications remain an important source of morbidity after Orthotopic Liver Transplantation (OLT). Identifying preoperative factors associated with these complications may help improve perioperative risk assessment and postoperative management. This study evaluated clinical predictors of early postoperative complications following OLT, with particular emphasis on preoperative hepatic encephalopathy.

We conducted a retrospective cohort study of adult patients who underwent OLT at the Organ Transplantation Center of The Affiliated Hospital of Qingdao University between January 2014 and December 2024. The primary endpoint was the occurrence of at least one clinically significant postoperative complication within 30 days after transplantation. Potential predictors were evaluated using univariate analyses followed by multivariable logistic regression. Model discrimination was assessed using receiver operating characteristic curve analysis.

Among 1,478 liver transplant recipients, 130 (8.8%) developed at least one early postoperative complication. On univariate analysis, body height, body weight, serum albumin, total bilirubin, international normalized ratio, intraoperative blood loss, hepatic encephalopathy, and ascites were associated with postoperative complications. In the multivariable model, preoperative hepatic encephalopathy remained independently associated with an increased risk of early postoperative complications (Odds Ratio [OR = 1.999]; 95% Confidence Interval [95% CI 1.23‒3.25]; p = 0.005). Greater intraoperative blood loss showed a borderline association with postoperative complications (OR = 1.00007; p = 0.052). The model demonstrated moderate discriminatory performance, with an area under the receiver operating characteristic curve of 0.699.

Preoperative hepatic encephalopathy was independently associated with early postoperative complications after OLT. These findings suggest that hepatic encephalopathy may be useful as a readily available marker for identifying recipients at increased postoperative risk. Further prospective and multicenter studies incorporating comprehensive donor, recipient, and perioperative variables are warranted to validate these findings and improve postoperative risk prediction.