Predicting Early Post-Transplant Mortality: The Role of ICU Stay in Liver Transplant Recipients with HBV-Related Cirrhosis

Objectives: Liver transplantation is the only treatment option for patients with end-stage liver disease. Hemodynamic, respiratory, and metabolic monitoring in the intensive care unit (ICU) is a vital step after the transplant procedure. While most recipients are discharged from the hospital within postoperative two weeks, some patients stay longer, which increases both morbidity and the costs of liver transplantation. We aimed to explore the implications of ICU stay for post-transplant early mortality.
Methods: This is a retrospective analysis of the liver transplant recipients with Hepatitis B virus (HBV)-related cirrhosis between January 2017 and June 2022. Patients ≥18 years with HBV-related cirrhosis were included in the study. The patients were analyzed in two groups: patients who survived (n=167) and patients with early mortality (n=11) defined as mortality within postoperative 90 days. Various operative and clinical data were compared among the groups.
Results: Post-transplant ICU stay was significantly longer in patients with mortality (11 (7-21) versus 5 (4-7), p<0.001). Although it was not statistically significant, the MELD score (20 (17-25) versus 17 (14-22), p=0.051) and postoperative severe complication rate (63.6% to 34.1%, p=0.058) tended to be higher in the mortality group. We performed a ROC curve analysis and showed that cut-off value for the length of ICU stay was 10.5 days in terms of 90-day mortality. The sensitivity was 64% and the specificity was 94% (the area under the curve = 0.820, 95% CI = 0.651- 0.990, p<0.001). In univariate analyses, duration of operation (HR = 1.005, 95% CI = 1.002-1.009, p=0.002) and ICU stay ≥10.5 days (HR = 19.855, 95% CI = 5.796-68.011, p<0.001) were found as significant variables, but in multivariate analyses, only the ICU stay ≥10.5 days (HR = 17.204, 95% CI = 3.881-76.265, p<0.001) was found as an independent predictor of early post-transplant mortality.
Conclusion: The prolonged ICU stay is an independent predictor of postoperative 90-day mortality in living donor liver transplantation for HBV-related cirrhosis. By using length of ICU stay, high risk patients can be determined and closely monitored for early detection and management of serious complications that may lead to early post-transplant mortality.