Prediction of hospital mortality after liver transplantation for acute liver failure

Abstract

BACKGROUND: The prognosis of acute liver failure (ALF) is dismal without a timely liver transplantation. Data on predicting hospital mortality after liver transplantation in such high urgency situation is scarce. Our aim was to identify factors associated with hospital mortality after liver transplantation for ALF. MATERIALS AND METHODS: From November 1991 to December 2007, 175 patients underwent liver transplantation for acute liver failure in our center. Among them, 32 patients had fulminant hepatic failure, and 143 patients had acute-on-chronic liver failure. Data including demographics, perioperative factors and postoperative outcomes were reviewed. Hospital mortality was defined as all causes of death within the same hospital admission after transplantation. Comparison was made between patients who survived (Group I) and died (Group II) after transplantation. Predictive factors for mortality were identified by multivariate analysis. P-value < 0.05 was considered to be significant. RESULTS: 130 patients received live donor liver transplantation and 45 patients received deceased donor liver transplantation. Acute flare up of hepatitis B infection was the most common etiology of ALF in our study (80%). The hospital mortality rate was 4.6% (n=8). There was no significant difference in age, co-morbid illness and etiology of ALF between the two groups. The incidence of infected ascites (P=0.046) and hepatorenal syndrome (P=0.003) were significantly higher in Group II. The median MELD score was 35 and 45 in group I and II, respectively (P=0.001). Perioperative blood transfusion requirement (P=0.001) and need for intraoperative haemodialysis (P=0.001) were also higher in Group II. Multivariate analysis identified preoperative serum urea level and perioperative haemodialysis to be factors associated with mortality after liver transplantation for ALF. All deaths occurred within 4.3 months after transplantation. The causes of mortality were fungal infection (n=2), thrombotic thrombocytopenic purpura (n=1), multiorgan failure (n=1), necrotizing pancreatitis (n=1), gut ischemia (n=1), intracranial hemorrhage (n=1) and pneumonia (n=1). The 3- and 5-year overall survival rates were both 95.4%. CONCLUSION: Liver transplantation for ALF could attain satisfactory short and long-term outcomes in these critically ill patients.