Prognostic Indicators and Risk Factors Associated With 30-Day Mortality After Liver Transplantation: A 13-Year Retrospective Cohort Study.

BACKGROUND

Early mortality following liver transplantation (LT) remains a critical challenge despite advancements in surgical techniques and immunosuppressive therapy. Timely identification of prognostic and risk factors is essential for improving postoperative outcomes.

METHODS

We conducted a retrospective cohort study at a tertiary referral center in Taiwan, analyzing 1,436 adult LT recipients from 2010 to 2023. Early mortality was defined as death occurring within 30 days post-transplantation. Clinical variables, operative data, and post-transplant complications were compared between the early mortality group (n=16) and non-early mortality group (n = 1420). Multivariate logistic regression was used to identify independent risk factors.

RESULTS

The 30-day mortality rate was 1.1%. Patients in the early mortality group had significantly higher Model for End-Stage Liver Disease scores (20.4 vs. 14.4, p = .001) and more frequently received deceased donor liver transplants (31.3% vs. 4.9%, p < .001). Multivariate analysis identified 4 independent risk factors for 30-day mortality following LT: deceased donor liver transplantation (Odds ratio [OR], 4.286), intraoperative blood loss per 1000 mL (OR, 1.062), catheter-related infection within 7 days (OR, 10.48), and graft failure or rejection (OR, 5.12).

CONCLUSION

Our findings highlight several critical and potentially modifiable predictors of early mortality following LT. Vigilant perioperative management, infection prevention, and tailored donor-recipient strategies are essential to reducing 30-day mortality and improving transplant outcomes.