Liver Transplantation and Outcome Predictors in Critical Care Unit
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- Category: Vol. 80, December 2012
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Liver Transplantation and Outcome Predictors in Critical Care Unit,MOSTAFA ELSHAZLY, MOHAMED EL-SHAFAY, SALLY SALAH ELDINE and MOHSEN AYOB
Abstract
Background and Study Aims: In the absence of cadaveric donor liver transplantation, living-donor liver transplantation (LDLT) is an alternative option for patients with end-stage liver disease. This may help to decrease waiting time. A shorter waiting time may reduce the risk of dying or of further deterioration that could render the patient too sick to undergo successful transplantation. This study aims at determination of early predictors for morbidity and mortality in these patients.
Patients and Methods: A Retrospective study enrolled 30 recipients, 24 males (80%) and 6 females (20%) who underwent Living Donor Liver Transplantation (from October 2004 to December 2008) at Cairo University Hospital. For all patients complete laboratory profile is done daily,as well as CRP and serum level of FK. Other laboratory work includes billirubin level, hemoglobin and hematocrite levels in the surgical drains. Continuous assessment of haemodynamics was done.
Results: From the 30 recipients, 24 males (80%) and 6 females (20%) Their mean age was 35±20 years old, ranging from 1 to 63 years old. The mortality rate was 26.7% (8 patients), causes of death were sepsis (62.5%), rejection (25%), and portal vein thrombosis (12.5%). There was positive impact of serum CRP levels during the early post-operative days, as an indicator of infection and inflammation, on the outcome and survival after LDLT (p=0.0001). CRP levels within normal range (5.16±3.6), had good outcome than patients with elevated CRP levels (22.09±7.9). Recipients of younger aged donors (29.2±5.3 years), had better outcome than those with more elderly donors (40.0±2.6 years). Tachy-cardic patients upon ICU admission always have a poor prognosis in comparison with patients that are not (p=0.008). platelet count was significantly higher in survivor with mean 108 vs 58.33 in non survivor p=0.02. Another predictor for outcome was the length of ICU stay post-operatively and outcome after LDLT (p=0.003).
Conclusion: A smooth ICU course after liver transplant is dependent on satisfactory graft function, which can be assessed by clinical parameters, some can be predictor for outcome as heart rate, laboratory test as CRP, stable platelet counts, declining transaminases.