Correlation between selected prognostic factors and a postoperative course in liver transplant recipients

The objective was to identify the major prognostic factors influencing the
liver function after the transplantation and predicting postoperative course and long-term survival in liver transplant recipients. We have analyzed results of biochemical, microbiological, serological, pathological studies of the donor and recipient, as well as intraoperative data (type of implantation, cold and warm ischemia time, total operation time, post-reperfusion syndrome, bile ducts drainage, degree of liver steatosis, anatomic variations). 215 of 542 liver transplant recipients (39.7%) were analyzed in the period 1989-2006. Patients were selected and divided according to the different mechanism leading to the liver disease. Group I - HCV infection, 80 patients (37.0%). Group II - HBV infection, 33 patients (15.0%). Group III - HBV and HCV infection, 13 patients (6.0%). Group IV - ALD, 66 patients (31.0%). Group V - AIH, 23 patients (11.0%). It was proved that patient survival prediction based on clinical parameters had a better prognostic value than prediction based only on the liver function tests. Transplant urgency scores: MELD, delta MELD and UNOS enables to predict early and long-term patient's survival after liver transplantation. Update of these scores, adequately to the patient's condition enables to evaluate effectively pre-transplantation life-threatening factors and urgency level. For organ donation predictive factors are: age, viral status and a degree of liver steatosis. Cold and warm ischemia time still has been a major prognostic factor. Routine biliary drainage resulted in worse long-term survival than in non-drained patients. Liver transplantation due to ALD was affected with the highest complications ratio. Chronic liver rejection occurred more frequently in AIH transplanted group. The most useful predictive factors of 1-year survival are liver function tests (AST, ALT, GGTP, INR, Quick) and urea/creatinine.

Keywords: Liver Transplantation