Risk factors in deceased donor liver transplantation: a single centre experience

S. Zubenko, A. Monakhov, M. Boldyrev, V. R. Salimov, A. D. Smolianinova, S. Gautier
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Abstract

Deceased brain-dead donor liver transplantation (LT) is a high-risk intervention. The outcome depends on a large number of modifiable and non-modifiable factors. Objective: to analyze our own experience and identify preoperative and perioperative prognostic factors for poor outcomes in LT. Materials and methods. The study included 301 liver transplants performed between January 2016 and December 2021. Donor and recipient characteristics, intraoperative data, perioperative characteristics including laboratory test data, and the nature and frequency of complications were used for the analysis. Results. The 1-, 3- and 5-year recipient survival rates were 91.8%, 85.1%, and 77.9%, respectively; graft survival rates were 90.4%, 83.7%, and 76.7%, respectively. The most significant predictors of poor outcome of LT on the recipient side were biliary stents (HR 7.203, p < 0.01), acutely decompensated cirrhosis (HR 2.52, p = 0.02); in the postoperative period, non-surgical infectious complications (HR 4.592, p < 0.01) and number of reoperations (HR 4.063, p < 0.01). Donor creatinine level (HR 1.004, p = 0.01, one factor analysis; HR 1.004, p = 0.016, multivariate analysis) was the only reliable prognostic negative factor. Conclusion. LT taking into account established risk factors will improve surgery outcomes and help personalize the therapy for each patient.
死亡供肝移植的危险因素:单一中心经验
脑死亡供体肝移植(LT)是一种高风险干预。结果取决于大量可改变和不可改变的因素。目的:分析我院临床经验,探讨lt预后不良的术前及围手术期影响预后的因素。该研究包括2016年1月至2021年12月期间进行的301例肝移植。供体和受体特征、术中数据、围术期特征(包括实验室检查数据)以及并发症的性质和频率用于分析。结果。受体1、3、5年生存率分别为91.8%、85.1%、77.9%;移植物存活率分别为90.4%、83.7%和76.7%。受体侧肝移植不良预后的最显著预测因子为胆道支架(HR 7.203, p < 0.01)、急性失代偿期肝硬化(HR 2.52, p = 0.02);术后非手术感染并发症(HR 4.592, p < 0.01)、再手术次数(HR 4.063, p < 0.01)。供体肌酐水平(HR 1.004, p = 0.01,单因素分析;HR 1.004, p = 0.016,多因素分析)是唯一可靠的预后阴性因素。结论。考虑到已确定的危险因素的LT将改善手术结果,并有助于为每位患者提供个性化治疗。
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