Fukazawa K, et al. - Researchers, herein, looked at the incidence of intracardiac and pulmonary thromboembolism (ICPTE), its risk factors and contribution to 24-hour mortality in adults who underwent liver transplantation for end-stage liver disease. Findings revealed a significant contribution of devastating ICPTE to the 24-hour mortality after adult cadaveric liver transplantation. In addition, its most significant risk factors could be expressed as an index with a good predictive accuracy.

Methods

• The design of the study was retrospective analysis of Standard Transplant Analysis and Research electronic database files.
• This study was performed in a perioperative setting.
• Researchers analyzed electronic files of 65,308 adult liver transplant recipients between 2002 and 2013 obtained from Organ Procurement and Transplantation Network.
• Mortality cause analysis and design of a multivariable logistic regression model were used for predicting the risk of 24-hour mortality due to devastating ICPTE.
• Perioperative mortality, donor and recipient demographics, donor cause of death, graft ischemic times, etiologies of recipient end-stage liver disease, functional status, comorbidities, and laboratory values were included as measurements.

Results

• This study included a total of 41,324 patients.
• Post-transplant 30 day survival was achieved in 38,293 (92.6%).
• Data reported that postoperative 24-hour mortality was 547 (1.3%) and 2484 (6.0%) within subsequent 30 days.
• Researchers observed that uncontrolled hemorrhage (57 patients, 0.14%), devastating ICPTE (54 patients, 0.13%) and primary graft failure (49 patients, 0.12%) contributed the most and equally to the 24-hour mortality.
• In multivariable regression analysis, significant independent hazard factors for the ICPTE included recipients' prior history of pulmonary embolism, portal vein thrombosis, functional status (Karnofsky score) <20, preoperative ventilator support, diabetes mellitus and Asian ethnicity.
• In addition, these risk factors were expressed as an index to calculate the overall hazard of a devastating ICPTE; c-statistics 0.70 (p < 0.001).