title: Emergency versus elective living-donor liver transplantation: a comparison of a single center analysis.
abstract: OBJECTIVE
  We studied the risk factors for postoperative mortality between patients who underwent emergency or elective living-donor liver transplantation (LDLT).
  
  
  METHODS
  Forty-seven patients underwent LDLT in our institute, 16 for emergencies and 31 as elective procedures. The emergency LDLT status was applied to cases in which the time period between referral to our institution and transplantation did not exceed 10 days, and in which liver failure was accompanied by the presence of any degree of hepatic encephalopathy.
  
  
  RESULTS
  With regard to preoperative factors, age (P = 0.03), the model for end-stage liver disease score (P = 0.001), preoperative tracheal intubation (P = 0.001), ratio between arterial oxygen tension and fractional inspired oxygen (PaO2/FiO2 ratio) (P = 0.03), steroid therapy use (P = 0.001), lymphocyte count (P = 0.02), and cases requiring hemodiafiltration (P = 0.001) differed significantly between the two groups. Postoperative pneumonia occurred more frequently in emergency LDLT patients than in elective LDLT patients (P = 0.006). Invasive pulmonary aspergillosis (IPA) was the main cause of postoperative death in emergency LDLT patients, and, in a univariate analysis, a preoperative status of high serum (1 → 3)-β-D: -glucan (>20 pg/ml, P = 0.001), advanced age (>52 years, P = 0.02), and a low PaO2/FiO2 ratio (<320, P = 0.01) were identified as factors predictive of IPA.
  
  
  CONCLUSIONS
  Careful perioperative management, including preoperative investigation of aspergillosis and empiric antibiotic therapy, should be considered for emergency LDLT patients who fulfill IPA risk factors.
authors: Department of Gastroenterological Surgery, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan. kazutake@yokohama-cu.ac.jp
authors: Kazuhisa
authors: K
authors: Takeda
authors: Kuniya
authors: K
authors: Tanaka
authors: Takafumi
authors: T
authors: Kumamoto
authors: Kazunori
authors: K
authors: Nojiri
authors: Ryutaro
authors: R
authors: Mori
authors: Koichi
authors: K
authors: Taniguchi
authors: Ryusei
authors: R
authors: Matsuyama
authors: Itaru
authors: I
authors: Endo
mesh_terms: D000328:Adult; D015984:Causality; D002423:Cause of Death; D015897:Comorbidity; D017558:Elective Surgical Procedures / Q000706:statistics & numerical data*; D004638:Emergency Treatment / Q000706:statistics & numerical data*; D005260:Female; D006501:Hepatic Encephalopathy / Q000401:mortality / Q000601:surgery; D017052:Hospital Mortality; D006801:Humans; D017093:Liver Failure / Q000401:mortality / Q000601:surgery; D016031:Liver Transplantation / Q000401:mortality*; D019520:Living Donors / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D011014:Pneumonia / Q000453:epidemiology; D011182:Postoperative Care; D011183:Postoperative Complications / Q000453:epidemiology; D011300:Preoperative Care; D055732:Pulmonary Aspergillosis / Q000453:epidemiology; D012372:ROC Curve; D012307:Risk Factors; D015996:Survival Rate; D016896:Treatment Outcome