An analysis of risk factors for early complications after liver transplantation

Objective To investigate the risk factors for early complications after liver transplantation and to improve the prognosis. Methods The clinical data of 147 patients who underwent orthotopic liver transplantation in the Hepatic Transplantation Center of The First Hospital of Jilin University from September 2011 to April 2017 were retrospectively analyzed. According to the presence or absence of early complications after surgery, these patients were divided into non-complication group (n = 11) and complication group (n = 136) . The possible factors associated with early complications after surgery were collected, including donor factors (age and whether the blood type of the donor matches that of the recipient) , recipient factors (sex, age, primary disease, Model for End-Stage Liver Disease [MELD]score, aspartate aminotransferase [AST], alanine aminotransferase[ALT], albumin [Alb], platelet [PLT], hemoglobin [Hb], fibrinogen, total bilirubin, creatinine, PLT/Alb ratio [PAR], and neutrophil/lymphocyte ratio [NLR]) , intraoperative factors (cold ischemia time, warm ischemia time, intraoperative blood loss, and duration of anhepatic phase) , and postoperative factors (AST and ALT immediately and 12, 24, 48, and 72 hours after operation) . The clinical data were analyzed to investigate the association between these factors and early complications.The t test was used for comparison of normally distributed continuous data; the Mann-Whitney U test was used for comparison of non-normally distributed continuous data. The chi-square test was used for comparison of categorical data. Backward logistic regression was used for multivariate analysis. Results MELD score (t =-3. 86, P = 0. 002) , Alb (t = 2. 19, P = 0. 049) , PLT (Z = 467. 00, P = 0. 039) , PAR (Z = 500. 00, P = 0. 068) , fibrinogen (t = 1. 80, P = 0. 096) , TBil (Z =-1. 98, P = 0. 047) , preoperative AST (Z = 417. 00, P =0. 015) , and preoperative ALT (Z = 501. 50, P = 0. 070) were associated with postoperative complications. PAR and preoperative AST were independent risk factors for early complications (odds ratio [OR]= 3. 84, 95% confidence interval [CI]: 1. 03-14. 34, P < 0. 05; OR =0. 25, 95% CI: 0. 07-0. 94, P < 0. 05) . The 147 patients were divided into high-PAR group (PAR ≥3 × 109/g; n = 55) and low-PAR group (PAR < 3 × 109/g; n = 92) ; PAR was associated with postoperative vascular and biliary complications (χ2= 2. 87, P = 0. 090;χ2= 3. 54, P = 0. 060) . The 147 patients were divided into normal preoperative AST group (AST < 40 U/L; n = 93) and abnormal preoperative AST group (AST ≥40 U/L; n = 54) ; preoperative AST level was associated with postoperative pleural effusion (χ2= 3. 03, P =0. 082) . Conclusion Fibrinogen, PLT, Alb, TBil, PAR, MELD score, and preoperative AST and ALT are associated with the development of early complications after liver transplantation, and PAR and preoperative AST are independent risk factors for early complications.To improve the prognosis and postoperative survival, these factors, particularly PAR, should be fully assessed for the liver transplantation recipient before operation, and specific interventions should be provided accordingly.