Early postoperative deaths of recipients after deceased donor liver transplantation

Abstract

Aim-Background

Liver transplant often results in haemodynamic and biochemical changes in the immediate postoperative period, often causing concern to the treating physician.

The aim

of the present study is to determine the preoperative clinical profile, along with the haematological and biochemical changes following deceased donor liver transplantation (DDLT) in the immediate 7-day postoperative period.

Method

A detailed assessment of the patients preoperative clinical diagnosis, presence of co-morbid illness and postoperative haematological, biochemical, and clinical events was made between survivors and those who died. Various parameters were compared between two groups to help us understand the variants that determined the early postoperative outcome in DDLT patients.

Results

A total of 26 patients were categorized into two groups: 18 patients were allocated to Group 1 (survivors) and 8 patients to Group 2 (mortality). There was no difference in the fluctuation of haemoglobin levels between the two groups. Early leukocytosis and persistent azotemia predicted early morbidity and mortality. A significant fall of platelet count predicted mortality. Transaminases showed a significant increase between the 2^nd and 3rd postoperative day, after which they stabilised and showed a downwards trend by the 7th to 9th postoperative day in both groups. Intraoperative events like cardiac arrhythmias, ischaemic cardiac events, pulmonary thromboembolism, hepatic artery thrombosis, sepsis and multiorgan failure rank among the causes of death.

Conclusion

Preoperative co-morbid illness, postoperative worsening azotemia, persistent leukocytosis, and sepsis and cardiac events in the immediate postoperative period are factors that appear to predict the outcome post DDLT.