Case Control Study
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jun 28, 2016; 22(24): 5548-5557
Published online Jun 28, 2016. doi: 10.3748/wjg.v22.i24.5548
Comprehensive risk assessment for early neurologic complications after liver transplantation
Si-Yuan Wu, Teng-Wei Chen, An-Chieh Feng, Hsiu-Lung Fan, Chung-Bao Hsieh, Kuo-Piao Chung
Si-Yuan Wu, Teng-Wei Chen, An-Chieh Feng, Hsiu-Lung Fan, Chung-Bao Hsieh, Division of Organ Transplantation Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei 11490, Taiwan
Kuo-Piao Chung, Chung-Bao Hsieh, Institute of Health Policy and Management, College of Public Health, National Taiwan University, Taipei 11490, Taiwan
Author contributions: Feng AC, Hsieh CB, Fan HL and Chen TW performed the research; Chung KP participated in the design of the study and performed the statistical analysis; Wu SY, Feng AC and Hsieh CB wrote the paper; all authors read and approved the final manuscript.
Supported by Tri-Service General Hospital, No. TSGH-C104-159.
Institutional review board statement: The study was approved by Institutional Review Board I of Tri-Service General Hospital, National Defense Medical Center (TSGHIRB No.100-05-220).
Informed consent statement: All transplantation procedures in the study were performed after approval of the Ethics Committee and informed consent from patients; Data were gathered retrospectively after approval of the IRB.
Conflict-of-interest statement: The authors declare no conflicts of interest.
Data sharing statement: Technical appendix, original data, and statistical code of manuscript are available from the corresponding author at albert0920@yahoo.com.tw.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Chung-Bao Hsieh, MD, PhD, Division of Organ Transplantation Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, No. 325, Cheng-Kung Rd, Sec2, Neihu 11490, Taipei, Taiwan. albert0920@yahoo.com.tw
Telephone: +886-933980018 Fax: +886-2-87927372
Received: March 11, 2016
Peer-review started: March 11, 2016
First decision: April 14, 2016
Revised: April 26, 2016
Accepted: May 21, 2016
Article in press: May 23, 2016
Published online: June 28, 2016
Processing time: 102 Days and 16 Hours
Abstract

AIM: To determine risk factors for early neurologic complications (NCs) after liver transplantation from perspective of recipient, donor, and surgeon.

METHODS: In all, 295 adult recipients were enrolled consecutively between August 2001 and February 2014 from a single medical center in Taiwan. Any NC in the first 30 d post-liver transplantation, and perioperative variables from multiple perspectives were collected and analyzed. The main outcome was a 30-d NC. Generalized additive models were used to detect the non-linear effect of continuous variables on outcome, and to determine cut-off values for categorizing risk. Risk factors were identified using multiple logistic regression analysis.

RESULTS: In all, 288 recipients were included, of whom 142 (49.3%) experienced at least one NC, with encephalopathy being the most common 106 (73%). NCs prolonged hospital stay (35.15 ± 43.80 d vs 20.88 ± 13.58 d, P < 0.001). Liver recipients’ age < 29 or ≥ 60 years, body mass index < 21.6 or > 27.6 kg/m2, Child-Pugh class C, history of preoperative hepatoencephalopathy or mental disorders, day 7 tacrolimus level > 8.9 ng/mL, and postoperative intra-abdominal infection were more likely associated with NCs. Novel risk factors for NCs were donor age < 22 or ≥ 40 years, male-to-male gender matching, graft-recipient weight ratio 0.9%-1.9%, and sequence of transplantation between 31 and 174.

CONCLUSION: NCs post- liver transplantation occurs because of factors related to recipient, donor, and surgeon. Our results provide a basis of risk stratification for surgeon to minimize neurotoxic factors during transplantation.

Keywords: Risk, Liver transplantation, Neurotoxicity syndromes, Donor, Learning curve

Core tip: The study uses generalized additive models and logistic regression in statistics to control confounders in the case-control study. We identified 11 risk factors for early neurologic complication after transplantation. From liver recipients’ perspective, age < 29 or ≥ 60 years, body mass index < 21.6 or > 27.6 kg/m2, Child-Pugh class C, history of preoperative hepatoencephalopathy or mental disorders, day 7 tacrolimus level > 8.9 ng/mL, and postoperative intra-abdominal infection were at risk. From donors’ perspective, age < 22 or ≥ 40 years, male-to-male gender matching, graft-recipient weight ratio 0.9%-1.9% was at risk. From surgeons’ perspective, sequence of transplantation between 31 and 174 were at risk.