To investigate the incidence and risk factors of immediate complications after orthotopic liver transplantation.

Clinical data of 1 079 patients undergoing orthotopic liver transplantation in the First Affiliated Hospital of Xi'an Jiaotong University from January 2014 to December 2023 were retrospectively analyzed. The informed consents of all patients and/or family members were obtained and the local ethical committee approval was received. Among them, 848 patients were male and 231 female, aged from 6 months to 71 years, with a median age of 48 years. Medical records and biochemical indexes of all patients were collected. The incidence and risk factors of immediate complications after orthotopic liver transplantation were evaluated. The risk factors of postoperative immediate complications were assessed by Logistic regression analysis.

The incidence of immediate complications after liver transplantation was 12.97%(140/1 079), among which the top five complications were postoperative infection [5.65%(61/1 079)], postoperative bleeding [3.34%(36/1 079)], other organ failure [3.24%(35/1 079)] and vascular complications [1.95%(21/1 079)], liver graft failure or immune rejection [1.30%(14/1 079)], respectively. Pulmonary infection (n=36) and abdominal infection (n=16) were the most common postoperative infections. Other organ failure mainly included postoperative renal failure (n=25). Among vascular complications, there were 14 cases of hepatic artery thrombosis after liver transplantation and 4 cases of portal vein thrombosis or stenosis after liver transplantation. The overall Charlson comorbidity index (CCI) score of all patients was (3.1±1.3). The CCI score of patients with immediate complications was (3.3±1.2), significantly higher than (3.0±1.3) of those without immediate complications (t=2.16, P<0.05). Multivariate Logistic regression analysis showed that CCI, TB, INR, admission to ICU, non-neoplastic liver diseases and alcoholic cirrhosis were the independent risk factors for immediate complications after liver transplantation (OR=1.428, 1.003, 1.857, 2.243, 2.159, 2.970; all P<0.05). The incidence of postoperative infection and bleeding in the high CCI group were 8.13%(23/283) and 5.30%(15/283), significantly higher than 4.77%(38/796) and 2.64%(21/796) in the low CCI group (χ²=4.401, 4.588; both P<0.05).

The incidence of immediate complications after liver transplantation is relatively high. The incidence of postoperative infection and bleeding is remarkably elevated in patients with CCI score of ≥4. Elevated CCI score, high bilirubin, high INR, admission to ICU, non-neoplastic liver diseases and alcoholic cirrhosis are the independent risk factors for immediate complications after liver transplantation.