Liver transplantation complications in the intensive care unit and at 6 months.
OBJECTIVE
This study sought to determine the factors that influence the 6-month outcomes of liver transplants.


METHODS
One hundred ninety-six variables (donor, recipient, operation, intensive care unit [ICU], evolution at 3 and 6 months) were collected from the first 74 consecutive liver transplantation performed from 2002 to 2004. The primary endpoint was patient survival at 6 months. The statistical analysis included a screening univariate analysis followed by a stepwise logistic regression with forward inclusion to test independent associations and finally generation of receiver-operator characteristic (ROC) curves to evaluate predictive factors.


RESULTS
Patient survival at 6 months was 86%, namely 10 deaths, including 4 intraoperatively and 6 postoperatively due to sepsis. Complications in the ICU were classified as reoperations due to biliary problems, vascular complications, and peritonitis. Late complications included 51% rejection episodes, 24% infections, 11% pleural effusions, and 16% diabetes mellitus. Logistic regression analysis showed independent negative predictors of survival were the number of packed red cells during transplantation, the number of fresh frozen plasma units administered in the ICU, blood urea nitrogen (BUN) concentration in the ICU, and graft complications. The odds ratios of these variables were 10.2, 5.2, 42.1, and 36.9, respectively. The area under the curve (AUC) of the ROC was 0.99; the sensitivity was 94%; and the specificity was 100%. The independent predictors of surgical complications were the length of the operation, the need for pressor support, and the number of fresh frozen plasma units administered in the operating room, with odds ratios of 1.0, 7.7, and 1.1, respectively.


CONCLUSIONS
This study revealed specific operative and ICU variables that correlated with the evolution of our patients.
Department of Intensive Care, Hospital Universitario Central de Asturias, Oviedo, Spain.
E
E
Tenza
C G
CG
Bernardo
D
D
Escudero
J
J
Otero
B
B
Quindós
A
A
Miyar
L
L
Vázquez
F
F
Taboada
M
M
Rodríguez
L
L
González-Dìéguez
I
I
González-Pinto
L
L
Barneo
D018806:APACHE; D000328:Adult; D000368:Aged; D003404:Creatinine / Q000097:blood; D003920:Diabetes Mellitus / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000453:epidemiology; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007239:Infections / Q000453:epidemiology; D007362:Intensive Care Units / Q000706:statistics & numerical data*; D007902:Length of Stay; D017093:Liver Failure / Q000601:surgery*; D016031:Liver Transplantation / Q000009:adverse effects* / Q000276:immunology / Q000401:mortality; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D010996:Pleural Effusion / Q000453:epidemiology; D011183:Postoperative Complications / Q000145:classification* / Q000453:epidemiology; D011517:Prothrombin Time; D012044:Regression Analysis; D012189:Retrospective Studies; D018805:Sepsis / Q000453:epidemiology / Q000401:mortality; D015996:Survival Rate; D013997:Time Factors; D055815:Young Adult
D007166:Immunosuppressive Agents; D003404:Creatinine