The Relative Factors Analysis Of Postoperative Complications During Liver Transplantation With Liver Failure Using Clavien-dindo Classification

Objective:Liver failure is a group of clinical syndrome,with coagulation mechanism and jaundice, hepatic encephalopathy, ascites as the main performance,which has acute onset and rapid progression, usually with severe and complicated clinical situations. Liver transplantation is an effective method. Therefore, each transplant center has always been committed to the development of liver transplantation techniques to reduce patients perioperative mortality and improve the long-term survival rate and survival quality. Postoperative complications are the important factors influencing the curative effect after liver transplantation, and to evaluate the reliability index of the quality of life after surgery. Clavien-Dindo classification is a postoperative complications classification for surgical complications. It is easy to statistics of postoperative complications in liver transplantation. The study was retrospectively analyzed postoperative complications of liver transplantation via Clavien-Dindo classification.The aim of this study was to analyze the related factors of above level Ⅲ b complications,to provide a reference for perioperative management. Methods:A retrospective analysis was performed of patients transplanted between 2004 and 2013. To explore the related influence factors of early postoperative serious complications, patients with ≧ Ⅲ b grade were defined serious complications group,the other were defined unserious complications group.The preoperative parameters were analyzed(gender, age, liver failure types, causes of liver failure, MELD score, Whether or not plasma exchange, cold ischemia time and marginal donor), as well as the intraoperative parameters(surgery way, with or without T tube, operative time, anhepatic phase, Bleeding volume in surgery and transfused packed red blood cells). The statistically significant factors as the independent variable were further analyzed using multiariable Logistic regression, and obtained related factors of early postoperative serious complications. Results:1.There were no significant differences in gender, age, liver failure types, causes of liver failure, operative time, anhepatic phase, Bleeding volume in surgery and transfused packed red blood cells, P>0.05.There were significant differences in preoperative MELD score, Whether or not plasma exchange, cold ischemia time, marginal donor, surgery way, with or without T tube, P<0.05.2. Logistic regression analysis showed that preoperative MELD score, Whether or not plasma exchange, surgery way, with or without T tube were all independent impact factors for early postoperative serious complications. The odds ratio of preoperative MELD ≥25 scores was 3.2 times higher than the group of preoperative MELD <25 scores.The odds ratio of the classic technique scores was 4.5 times higher than the group of the piggyback technique.The odds ratio of T tube was 2.4 times higher than the group of no T tube.The odds ratio of plasma exchange was 0.3 times higher than the group of no plasma exchange. Conclusion:Clavien-Diondo classification facilitated statistic early postoperative complications in application of liver transplantation, particularly serious complications.The liver failure patients with preoperative MELD ≥25 scores or T tube were easier to occur early postoperative serious complications; The liver failure patients with preoperative plasma exchange or the piggyback technique were less to occur early postoperative serious complications. Marginal donor affect with early postoperative complications after liver transplantation in liver failure patients. However, they were not dependent of influential factors of early postoperative complications.