A critical analysis of early death after adult liver transplants.
BACKGROUND
The 15% mortality rate of liver transplant recipients at one yr may be viewed as a feat in comparison with the waiting list mortality, yet it nonetheless leaves room for much improvement. Our aim was to critically examine the mortality rates to identify high-risk periods and to incorporate cause of death into the analysis of post-transplant survival.


METHODS
We performed a retrospective analysis on United Network for Organ Sharing data for all adult recipients of liver transplants from January 1, 2002 to October 31, 2011. Our analysis included multivariate logistic regression where the primary outcome measure was patient death of 49,288 recipients.


RESULTS
The highest mortality rate by day post-transplant was on day 0 (0.9%). The most significant risk factors were as follows: for one-d mortality from technical failure, intensive care unit admission odds ratio (OR 3.2); for one-d mortality from graft failure, warm ischemia >75 min (OR 5.6); for one-month mortality from infection, a previous transplant (OR 3.3); and for one-month mortality from graft failure, a previous transplant (OR 3.7).


CONCLUSIONS
We found that the highest mortality rate after liver transplantation is within the first day and the first month post-transplant. Those two high-risk periods have common, as well as different, risk factors for mortality.
Division of Abdominal Transplantation, Department of Surgery, University of Arizona, Tucson, AZ 85718, USA. arana@surgery.arizona.edu
Abbas
A
Rana
Bruce
B
Kaplan
Tun
T
Jie
Marian
M
Porubsky
Shahid
S
Habib
Horacio
H
Rilo
Angelika C
AC
Gruessner
Rainer W G
RW
Gruessner
D000293:Adolescent; D000328:Adult; D000368:Aged; D002423:Cause of Death; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006085:Graft Survival; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D017093:Liver Failure / Q000601:surgery*; D016031:Liver Transplantation / Q000401:mortality* / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000401:mortality*; D011379:Prognosis; D012042:Registries; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D009927:Tissue and Organ Procurement; D014850:Waiting Lists; D055815:Young Adult
cause of death; liver transplantation; risk factors; survival