Predictors of Mortality in Living Donor Liver Transplantation.

BACKGROUND: Egypt has the highest prevalence of the world hepatitis C virus (HCV) load. Hence, the problem of end-stage liver disease (ESLD) is considered a huge burden on the community. Living donor liver transplantation (LDLT) is the only source of donation in Egypt till now. Survival rates had shown significant improvement in the past decades. This study provides analysis of the mortality rates and possible predictors of mortality following LDLT. It also aids in developing a practical and easy-to-apply risk index for prediction of early mortality. PATIENTS AND METHODS: This study is a retrospective study that was designed to analyze data from 128 adult patients with ESLD who underwent LDLT in the Liver Transplantation Unit at Faculty of Medicine, Cairo University. Early and late mortality were identified. All potential risk factors were tested using univariate regression for association with early and late mortality. Significant variables were then entered into a multivariable logistic regression model for identifying the predictors for mortality. RESULTS: Sepsis was the most common cause of early mortality. Early mortality and 1-year mortality were 29 (23%) and 23 (18%), respectively. Model for End-Stage Liver Disease (MELD) score, intraoperative packed red blood corpuscles (RBCs), and duration of intensive care unit (ICU) stay were found to be independently associated with early mortality. CONCLUSION: A MELD score >20, intraoperative transfusion >8 units of packed RBCs, and ICU stay >9 days are three independent predictors of early mortality. Their incorporation into a combined Risk Index can be used to improve outcomes of LDLT.

Exploring Portal Vein Hemodynamic Velocities as a Promising, Attractive Horizon for Small-for-Size Syndrome Prediction After Living-Donor Liver Transplantation: An Egyptian Center Study.

BACKGROUND: Liver transplantation is the only definite treatment for patients with irreversible liver failure. This explored the impact of portal vein hemodynamic velocities on graft functions to determine the mean portal vein velocities that may increase small-for-size syndrome (SFSS) risk. METHODS: The study was conducted with 123 cirrhotic patients who underwent living-donor liver transplantation (LDLT) at Kasr Alainy Hospital, Cairo, Egypt. Patients were submitted to full history, examination, pre-transplantation labs, and imaging. Intra-operative Doppler studies were performed after graft reperfusion. Post-operative (PO) Doppler was performed once a day over the first 2 weeks. Complete graft functions were obtained daily for patients. RESULTS: PVV (portal vein velocities) declined gradually but significantly after LT (intra-operative), and PO PVV were significantly higher in the SFSS group. The best cut-off values for prediction of SFSS with the use of intra-operative (before, during, and after) post-anastomotic PVV were 55.5, 106, and 126.5 cm/s, respectively, and, for PO before and after anastomotic PVV, 48.6 and 71.1 cm/s, respectively. There was a significant positive correlation between PO mean PVV and mean alanine transferase, total bilirubin, and international normalized ratio. CONCLUSIONS: PVV is a significant hemodynamic factor that influences graft functions. SFSS, which has a negative impact after LDLT, could be predicted by cut-off values for PVV, and therefore preventive measures such as splenectomy may be considered for its prevention.

Different Score Systems to Predict Mortality in Living Donor Liver Transplantation: Which Is the Winner? The Experience of an Egyptian Center for Living Donor Liver Transplantation.

INTRODUCTION: Many scoring systems have been proposed to predict the outcome of deceased donor liver transplantation. However, their impact on the outcome in living donor liver transplantation (LDLT) has not yet been elucidated. This study sought to assess performance of preoperative Model for End-Stage Liver Disease (MELD) score in predicting postoperative mortality in LDLT and to compare it with other scores: MELDNa, United Kingdom End-Stage Liver Disease (UKELD), MELD to serum sodium ratio (MESO), updated MELD, donor age-MELD (D-MELD) and integrated MELD (iMELD). METHODS: We retrospectively analyzed data from 86 adult Egyptian patients who underwent LDLT in a single center. Preoperative MELD, MELDNa, MESO, UKELD, updated MELD, D-MELD, and iMELD were calculated. Receiver-operator characteristic (ROC) curves and area under the curve (AUC) were used to assess the performance of MELD and other scores in predicting postoperative mortality at 3 months (early) and 12 months. RESULTS: Among the 86 patients, mean age 48 ± 7 years, 76 (88%) were of male sex and 27 (31.4%) had died. Preoperative MELD failed to predict early mortality (AUC = 0.63; P = .066). Comparing preoperative MELD with other scores, all other scores had better predictive ability (P < .05), with D-MELD on the top of the list (AUC = 0.68, P = .016), followed closely by UKELD (AUC = 0.67, P = .025). After that were iMELD, MESO, and MELDNa with the same predictive performance (AUC = 0.65; P < .05); updated MELD had the lowest prediction (AUC = 0.640; P = .04). Moreover, all scores failed to predict mortality at 12 months (P > .05). CONCLUSIONS: Preoperative MELD failed to predict either early or 1-year mortality after LDLT. D-MELD, UKELD, MELDNa, iMELD, and MESO could be used as better predictors of early mortality than MELD; however, we need to develop an effective score system to predict mortality after LDLT.