Multiple organ failure after liver transplantation.
OBJECTIVE
To examine the effect of multiple organ failure after liver transplantation on mortality and resource utilization.


METHODS
Retrospective cohort study.


METHODS
Surgical intensive care unit in a tertiary care university hospital.


METHODS
Consecutive series of 113 adults undergoing liver transplantation between 1984 and 1992. Patients were excluded if they died intraoperatively (n = 2), required retransplantation (n = 8), or had incomplete records (n = 7).


METHODS
None.


RESULTS
We prospectively developed definitions for organ failure, and quantitated the frequency and related outcomes for mortality and resource utilization. Multiple organ failure was defined as the presence of two or more organ failures. Patients were grouped according to the presence (n = 31) or absence (n = 65) of multiple organ failure. Preoperative severity of illness was assessed by the Acute Physiology and Chronic Health Evaluation (APACHE II) and United Network for Organ Sharing (UNOS) scoring systems. Postoperative outcome data, including hospital survival rate, hospital length of stay, and charges were recorded. The frequency of multiple organ failure after liver transplantation was 32%. The mortality rate in the patients who developed multiple organ failure was 42% vs. only 2% in those patients without multiple organ failure (p < .0001). Patients with four or more organ failures had a 100% mortality rate. Postoperative multiple organ failure was associated with increased hospital length of stay (46 +/- 7 days vs. 29 +/- 2 days; p = .026) and increased hospital charges ($271,497 +/- 29,994 vs. $136,372 +/- 8,310; p < .0001). Higher preoperative APACHE II and UNOS scores predicted postoperative multiple organ failure, but were less accurate tools for predicting risk of death.


CONCLUSIONS
Multiple organ failure is associated with death and increased resource utilization in liver transplantation. Pretransplantation severity of illness, as measured by APACHE II and UNOS scoring systems, is an important determinant of postoperative multiple organ failure and outcome.
Spanier
T B
TB
Department of Surgery, New England Medical Center Hospitals, Boston, MA 02111.
Klein
R D
RD
Nasraway
S A
SA
Rand
W M
WM
Rohrer
R J
RJ
Freeman
R B
RB
Schwaitzberg
S D
SD
D018806:APACHE; D000293:Adolescent; D000328:Adult; D000368:Aged; D015331:Cohort Studies; D003365:Costs and Cost Analysis; D005260:Female; D015276:Health Care Rationing; D006801:Humans; D007902:Length of Stay / Q000191:economics; D016031:Liver Transplantation / Q000191:economics / Q000401:mortality; D008297:Male; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000401:mortality* / Q000628:therapy; D017063:Outcome Assessment, Health Care; D011183:Postoperative Complications / Q000401:mortality*; D012189:Retrospective Studies; D015996:Survival Rate