Preoperative and Intraoperative Predictors of Postoperative Morbidity, Poor Graft Function, and Early Rejection in 190 Patients Undergoing Liver Transplantation
| Autor: | Daniel M. Levine, Dennis E. Feierman, Patricia A. Sheiner, Elliott Bennett-Guerrero, Mark L. White, Wanda J. Winfree, Stephen F. Carroll, Michael K. Parides, Michael G. Mythen, G. Robin Barclay, Thomas S. Parker |
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| Rok vydání: | 2001 |
| Předmět: |
Graft Rejection
Male medicine.medical_specialty Multivariate analysis medicine.medical_treatment Liver transplantation Preoperative care Cohort Studies Risk Factors medicine Humans Prospective Studies Risk factor Univariate analysis business.industry Cholesterol HDL Length of Stay Middle Aged Liver Transplantation Surgery Transplantation Treatment Outcome Liver Creatinine Immunoglobulin G Multivariate Analysis Female Complication business Cohort study |
| Zdroj: | Archives of Surgery. 136:1177 |
| ISSN: | 0004-0010 |
| Popis: | Hypothesis Preoperative and intraoperative variables predict in part adverse outcome after liver transplantation. Design Prospective, blinded, cohort study. Setting Tertiary care hospital. Subjects A total of 190 adult patients undergoing primary liver transplantation. Main Outcome Measure Adverse outcome was prospectively defined as either in-hospital death or prolonged postoperative hospitalization (>14 days) associated with morbidity. Potential preoperative and intraoperative risk factors were collected. Associations were tested by univariate analysis followed by multivariate analysis in which preoperative factors were entered before intraoperative factors. Results Adverse outcome occurred in 44.7% of patients. Incidences of other complications were as follows: in-hospital mortality (8.4%), primary graft nonfunction (4.2%), poor early graft function (1.1%), and early rejection (31.2%). Univariate predictors of adverse outcome were United Network for Organ Sharing status ( P = .003), Child-Turcotte-Pugh score ( P = .02), POSSUM physiological score ( P = .002), recipient age ( P = .01), preoperative serum high-density lipoprotein cholesterol level ( P = .03), preoperative serum creatinine level ( P = .002), preoperative serum total IgG level ( P = .004), duration in hospital preoperatively ( P = .03), operative duration ( P P P = .002), and use of inotropic agents ( P = .01). In the final multivariate model, predictors of adverse outcome were United Network for Organ Sharing status ( P = .03), recipient age ( P = .002), and total intraoperative fluids ( P = .04). Most patients who died or had a prolonged hospitalization exhibited dysfunction of more than 1 organ system, including pulmonary, renal, and infectious complications. Conclusions Adverse outcome occurs frequently after liver transplantation, usually involves multiple organ systems, and is predicted in part by several preoperative and intraoperative factors. |
| Databáze: | OpenAIRE |
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