To explore the risk factors of early severe complications in patients with liver failure after liver transplantation.

Clinical data of 132 patients with liver failure who initially underwent orthotopic liver transplantation in Beijing You'an Hospital, Capital Medical University from January 2004 to December 2013 were retrospectively analyzed. The informed consents of all patients were obtained and the local ethical committee approval was received. Among them, 109 patients were male and 23 female, aged (44±10) years on average. According to the Clavien-Dindo classification, patients with early postoperative complications of grade Ⅲb or above were assigned into the severe complication group (n=41), and those with complications below grade Ⅲb were allocated into the non-severe complication group (n=91). Univariate analysis of the risk factors of severe complications was performed by t test or Chi-square test. Multivariate analysis was conducted by Logistic regression analysis.

Univariate analysis showed that preoperative MELD score, preoperative plasma exchange, cold ischemia time, marginal donor, surgical pattern and intraoperative T-tube indwelling were significantly correlated with the incidence of early severe complications after liver transplantation for liver failure (χ²=4.425, 5.069, 5.672, 4.105, 6.352, 6.293; P<0.05). Multivariate Logistic regression analysis demonstrated that preoperative MELD score≥25, classic liver transplantation and intraoperative T-tube indwelling were the independent risk factors for early severe complications after liver transplantation in patients with liver failure (OR=3.202, 4.510, 3.047; P<0.05), and preoperative plasma exchange was an independent protective factor (OR=0.330, P<0.05).

Preoperative MELD score≥25, classic liver transplantation and intraoperative T-tube indwelling are more likely to cause early severe complications in liver failure patients after liver transplantation, whereas preoperative plasma exchange can lower the risk of early severe complications.