To evaluate the clinical efficacy and its influencing factors of liver transplantation for grade Ⅳ hepatic coma.

Clinical data of 16 patients with hepatic coma who underwent liver transplantation in the 900^th Hospital from January 2011 to December 2022 were retrospectively analyzed. Among them, 14 patients were male and 2 female, aged from 29 to 67 years, with a median age of 48 years. All patients had the symptom of hepatic encephalopathy before surgery, which met the diagnostic criteria of grade Ⅳ hepatic encephalopathy (hepatic coma) according to the West-Haven classification system. The duration of hepatic coma was 1-14 d with a median of 7 d. The informed consents of all patients were obtained and the local ethical committee approval was received. All patients received orthotopic liver transplantation with retrograde perfusion of the inferior vena cava. According to the 1-year survival of post-liver transplantation, they were divided into the survival and death groups. Perioperative conditions, postoperative complications and survival between two groups were compared by t test, rank-sum test and Fisher's exact test. Clinical efficacy and its influencing factors of liver transplantation for hepatic coma were analyzed.

The 1-year survival rate in the survival group was 63%(10/16), 3 cases died of primary graft dysfunction, 2 cases of severe infection and 1 case of brain death. In the survival group,9 cases underwent donation after brain death (DBD) donors and 2 cases of DBD donors in the death group, and the difference was statistically significant (P=0.018). In the survival group, the average intraoperative blood transfusion was (1 840±273) ml, significantly less than (3 550±1 750) ml in the death group (t=-2.640, P<0.05). In the survival group, the median Scr level after surgery was 53(47, 109) μmol/L, significantly lower than 205(84, 278) μmol/L in the death group (Z=-2.218, P<0.05). In the survival group, the postoperative WBC was (10±4)×10⁹/L, significantly lower than (15±4)×10⁹/L in the death group (t=-2.787, P<0.05). The Plt in the survival group was (62±15)×10⁹/L, significantly higher than (39±25)×10⁹/L in the death group (t=2.270, P<0.05).

Liver transplantation is an effective life-saving treatment for patients with grade Ⅳ hepatic coma. High-quality donor liver, protection of liver and kidney function, improvement of coagulation function, severe infection control and reasonable intraoperative blood transfusion play key roles in enhancing postoperative survival rate of liver transplantation recipients with hepatic coma.