Preoperative risk factor analysis in orthotopic liver transplantation with pretransplant artificial liver support therapy.
OBJECTIVE
To assess the value of pre-transplant artificial liver support in reducing the pre-operative risk factors relating to early mortality after orthotopic liver transplantation (OLT).


METHODS
Fifty adult patients with various stages and various etiologies undergoing OLT procedures were treated with molecular adsorbent recycling system (MARS) as preoperative liver support therapy. The study included two parts, the first one is to evaluate the medical effectiveness of single MARS treatment with some clinical and laboratory parameters, which were supposed to be the therapeutical pre-transplant risk factors, the second part is to study the patients undergoing OLT using the regression analysis on preoperative risk factors relating to early mortality (30 d) after OLT.


RESULTS
In the 50 patients, the statistically significant improvement in the biochemical parameters was observed (pre-treatment and post-treatment). Eight patients avoided the scheduled Ltx due to significant relief of clinical condition or recovery of failing liver function, 8 patients died, 34 patients were successfully bridged to Ltx, the immediate outcome of this 34 patients within 30 d observation was: 28 kept alive and 6 patients died.


CONCLUSIONS
Pre-operative SOFA, level of creatinine, INR, TNF-alpha, IL-10 are the main preoperative risk factors that cause early death after operation, MARS treatment before transplantation can relieve these factors significantly.
Yuan
Jin-Zhong
JZ
Blood Purification Center, Xiangya Transplantation Institute, Third Xiangya Hospital of Central South University, Changsha 410013, Hunan Province, China. yuanjz1229@vip.sina.com
Ye
Qi-Fa
QF
Zhao
Ling-Ling
LL
Ming
Ying-Zi
YZ
Sun
Hong
H
Zhu
Shai-Hong
SH
Huang
Zu-Fa
ZF
Wang
Min-Min
MM
D000368:Aged; D005163:Factor Analysis, Statistical; D005260:Female; D006085:Graft Survival; D006801:Humans; D017093:Liver Failure / Q000628:therapy*; D017114:Liver Failure, Acute; D016031:Liver Transplantation / Q000379:methods*; D019164:Liver, Artificial; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D016896:Treatment Outcome