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BACKGROUND: Patients with a Sequential Organ Failure Assessment (SOFA) score >7 on post-transplant day (POD) 7 have been reported to have a higher risk of short-term mortality after living donor liver transplant (LDLT). We sought to identify factors that were associated with early mortality in this high-risk population.
MATERIAL AND METHODS: A total of 102 patients with a high SOFA score (>7) on POD 7 were enrolled, of which 72 (70.6%) were assigned to the survivor group, and the other 30 (29.4%) patients were assigned to the non-survivor group according to post-transplant 3-month results. Demographics, clinical data, operative parameters, and individual SOFA component scores were collected. Independent risk factors for 3-month mortality were identified by multivariate logistic regression analysis using backward elimination procedures.
RESULTS: Of 102 high SOFA score patients, the 3-month mortality rate after LDLT in our study was 29.4%. Four independent risk factors were indicative for early death: graft-to-recipient weight ratio (GRWR) <0.8 (hazard ratio [HR]=3.00; 95% CI=1.05-8.09; P=0.041), longer warm ischemia time (HR=37.84; 95% CI=1.63-880.77; P=0.024), high liver component of the SOFA score, and cardiovascular component of the SOFA score (liver component: HR=10.39; 95% CI=1.77-60.89; P=0.009 and cardiovascular component: HR=13.34; 95% CI=2.22-80.12; P=0.005).
CONCLUSIONS: In conclusion, 3-month mortality among patients with high SOFA score on POD 7 is associated with multiple independent risk factors, including smaller GRWR, longer warm ischemia time, and higher category of liver and cardiovascular component of SOFA score. By recognizing high-risk patients earlier, the LDLT outcomes may be improved by timely intensive therapies.

Keywords: Liver Transplantation, Risk Factors, Survival Analysis