Predictors of early recipient mortality after living donor liver transplantation in a tertiary care center in Egypt

The Survival Rate of Living-Donor Liver Transplantation Between Same-Sex and Opposite-Sex Recipients

Purpose: Living-donor liver transplantation (LDLT) serves as a solution for patients facing end-stage liver disease. The existing literature indicates that sex differences between transplant donors and recipients might influence survival rates. Methods: We used a retrospective study design to investigate the impact of different sex pairings on the survival rates of adult LDLT recipients. This study involved the long-term tracking of recipients who underwent LDLT between 7 June 2000 and 31 December 2021. Results: In total, 169 pairs (37.1%) of male recipients with male donors, 145 pairs (31.8%) of male recipients with female donors, 77 pairs (16.9%) of female recipients with female donors, and 65 pairs (14.3%) of female recipients with male donors were submitted for analysis. With independent t-tests or chi-squared tests demonstrating that liver weight and graft-to-recipient weight ratio (GRWR) for same-sex LDLT recipients were significantly higher than opposite-sex recipients; significant differences in disease diagnoses between same-sex and opposite-sex LDLT recipients were found. The Kaplan-Meier survival curve indicates that while same-sex pair survival rates were higher than opposite-sex pairs, the difference was not statistically significant. Conclusions: While sex matching might have some impact on survival rates, it is influenced by a variety of factors, so the effects of donor and recipient sex matching on liver transplantation remains controversial. The findings of this study can serve as a reference for living-donor liver transplant teams when making donor selection decisions.

Effects of immediate extubation in the operating room on long-term outcomes in living donor liver transplantation: a retrospective cohort study

BACKGROUND

Living-donor liver transplantation (LDLT) is a viable alternative to deceased-donor liver transplantation. Enhanced recovery after surgery protocols that include early extubation offer short-term benefits; however, the effect of immediate extubation in the operating room (OR) on long-term outcomes in patients undergoing LDLT remains unknown. We hypothesized that immediate OR extubation is associated with improved long-term outcomes in patients undergoing LDLT.

METHODS

This retrospective cohort study included 205 patients who underwent LDLT. The patients were classified based on the extubation location as OREX (those extubated in the OR) or NOREX (those extubated in the intensive care unit [ICU]). The primary outcome was overall survival (OS), while secondary outcomes included ICU stay, hospital stay duration, and various postoperative outcomes.

RESULTS

Among the 205 patients, 98 (47.8%) underwent extubation in the OR after LDLT. Univariate analysis revealed that OR extubation did not significantly affect OS (hazard ratio [HR]: 0.50, 95% confidence interval [CI]: 0.24-1.05; P = 0.066). Furthermore, multivariate analysis revealed no statistically significant association between OR extubation and OS (HR: 0.79, 95% CI: 0.35-1.80; P = 0.580). However, OR extubation was significantly associated with a lower incidence of 30-day composite complications and shorter ICU and hospital stays. Multivariate analysis indicated that higher preoperative platelet counts, increased serum creatinine levels, and a longer surgery duration were associated with poorer OS.

CONCLUSIONS

Immediate OR extubation following LDLT surgery was associated with fewer 30-day composite complications and shorter ICU and hospital stays; however, it did not significantly improve OS compared with ICU extubation.

Effects of Peroperative Cold Ischemia Time and Anhepatic Phase in Adult Living Donor Liver Transplant Recipients: Operation Time That is Not Affected by the Anhepatic Phase But is Prolonged by Cold Ischemia Time

OBJECTIVE

It was aimed to examine the overall role of cold ischemia time and anhepatic phase durations in terms of peroperative blood transfusion needs, hospital stay conditions and postoperative charges, and survival in recipients.

MATERIAL AND METHODS

One hundred forty-eight adult living donor liver transplant recipients (18 years and older) were included in the study. Whether the anhepatic phase and cold ischemia duration have an effect on the rates of surgery time, blood product transfusion, total hospital and intensive care unit stay, postoperative biliary complications, hepatic vein thrombosis, portal vein thrombosis, early postoperative bleeding, sepsis, and primary graft dysfunction. Was analyzed statistically. In addition, the effect of the anhepatic phase and cold ischemia time on graft survival was statistically examined by creating an average of the patient follow-up period.

RESULTS

It was observed that the operation time increased statistically as the cold ischemia time increased (P = .000). No statistically significant relationship was found between other findings and cold ischemia time and anhepatic phase.

CONCLUSION

Prolonged surgery time due to increased cold ischemia time may be an important finding in terms of peroperative and postoperative results of the graft.

In-hospital mortality of liver transplantation and risk factors: a single-center experience

Background

Liver transplantation (LT) is a life-saving treatment for patients with end-stage liver disease and acute liver failure. However, in-hospital death cannot be avoided. We designed this study to analyze patients' in-hospital mortality rate after LT and the factors correlated with in-hospital death.

Methods

The data of patients who received LT in our hospital between January 11, 2015, and November 19, 2019, were obtained from the China Liver Transplant Registry and medical records. The in-hospital mortality rate was calculated, and factors related to mortality, cause of death, and factors related to cause of death were analyzed by reviewing patients' data.

Results

A total of 529 patients who underwent cadaveric LT were enrolled in this study. Modified piggyback orthotopic LT was performed for all patients. Seventy patients died in the hospital after LT, and the in-hospital mortality rate was 13.2%. Factors including model for end-stage liver disease (MELD) score, Child-Pugh grading, intraoperative blood loss, and anhepatic phase were correlated with in-hospital death. MELD score and intraoperative blood loss were determined as the two independent risk factors of in-hospital death. The first two causes of death were infection (34.3%) and primary non-function (15.7%). Pulmonary fungal infection was the main cause of infectious death. MELD score was the independent risk factor for infectious death, and both body mass index of donors and cold ischemic time were independent risk factors of primary non-function.

Conclusions

In-hospital death poses a threat to certain patients undergoing LT. Our study suggests that the main cause of in-hospital death is an infection, followed by primary non-function.