Akademik Veri Yönetim Sistemi
journal of inonu liver transplantation institute, cilt.1, sa.3, ss.107-112, 2024 (Hakemli Dergi)
Objectives: Liver transplantation is the only treatment option for patients with end-stage liver disease. Hemodynamic, respiratory,
and metabolic monitoring in the intensive care unit (ICU) is a vital step after the transplant procedure. While most recipients are
discharged from the hospital within postoperative two weeks, some patients stay longer, which increases both morbidity and the
costs of liver transplantation. We aimed to explore the implications of ICU stay for post-transplant early mortality.
Methods: This is a retrospective analysis of the liver transplant recipients with Hepatitis B virus (HBV)-related cirrhosis between
January 2017 and June 2022. Patients ≥18 years with HBV-related cirrhosis were included in the study. The patients were analyzed
in two groups: patients who survived (n=167) and patients with early mortality (n=11) defined as mortality within postoperative
90 days. Various operative and clinical data were compared among the groups.
Results: Post-transplant ICU stay was significantly longer in patients with mortality (11 (7-21) versus 5 (4-7), p<0.001). Although
it was not statistically significant, the MELD score (20 (17-25) versus 17 (14-22), p=0.051) and postoperative severe complication
rate (63.6% to 34.1%, p=0.058) tended to be higher in the mortality group. We performed a ROC curve analysis and showed that
cut-off value for the length of ICU stay was 10.5 days in terms of 90-day mortality. The sensitivity was 64% and the specificity was
94% (the area under the curve = 0.820, 95% CI = 0.651- 0.990, p<0.001). In univariate analyses, duration of operation (HR = 1.005,
95% CI = 1.002-1.009, p=0.002) and ICU stay ≥10.5 days (HR = 19.855, 95% CI = 5.796-68.011, p<0.001) were found as significant
variables, but in multivariate analyses, only the ICU stay ≥10.5 days (HR = 17.204, 95% CI = 3.881-76.265, p<0.001) was found as an
independent predictor of early post-transplant mortality.
Conclusion: The prolonged ICU stay is an independent predictor of postoperative 90-day mortality in living donor liver transplantation
for HBV-related cirrhosis. By using length of ICU stay, high risk patients can be determined and closely monitored for early
detection and management of serious complications that may lead to early post-transplant mortality.