Early postoperative weight gain is associated with increased risk of graft failure in living donor liver transplant recipients

Abstract

Fluid overload (FO) has been shown to adversely affect multiple organs and survival in critically ill patients. Liver transplantation (LT) carries the risk of massive transfusion, which frequently results in FO. We investigated the association of postoperative weight gain with graft failure, early allograft dysfunction (EAD), and overall mortality in LT. 1833 living donor LT (LDLT) recipients were retrospectively analysed. Patients were divided into 2 groups according to postoperative weight gain (<3% group [n = 1391] and ≥3% group [n = 442]) by using maximally selected log-rank statistics for graft failure. Multivariate Cox and logistic regression analyses were performed. The ≥3% group was associated with graft failure (adjusted HR [aHR], 1.763; 95% CI, 1.248-2.490; P = 0.001). When postoperative weight change was used as a continuous variable, the aHR for each 1% increase in postoperative weight was 1.045 (95% CI, 1.009-1.082; P = 0.015). In addition, the ≥3% group was associated with EAD (adjusted OR [aOR], 1.553; 95% CI, 1.024-2.356; P = 0.038) and overall mortality (aHR, 1.731; 95% CI, 1.182-2.535; P = 0.005). In conclusion, postoperative weight gain may be independently associated with increased risk of graft failure, EAD, and mortality in LDLT recipients.

Figure 1

Flowchart of the study population. Abbreviations: LT, liver transplantation; OLT, orthotopic liver transplantation; sCr, serum creatinine; LDLT, living donor liver transplantation.

Figure 2

(a) Graft and (b) patient survival rates stratified by postoperative weight gain (<3% or ≥3%) in living donor liver transplantation recipients. Survival curves are provided with 95% confidence intervals.

Figure 3

Postoperative weight change and risk of graft failure in living donor liver transplantation recipients. The solid black line represents the adjusted hazard ratio for the association between postoperative weight change and graft failure, and grey shading represents the 95% confidence interval of the estimate. Postoperative weight change was modelled with restricted cubic splines with 5 knots (5^th, 27.5^th, 50^th, 72.5^th, and 95^th percentiles) in a multivariate Cox model, which was adjusted for all variables in Table 2.

Figure 4

Sequential changes in mean (a) CRP and (b) NLR values in living donor liver transplantation recipients, *P < 0.05. Abbreviations: CRP, C-reactive protein; NLR, neutrophil-to-lymphocyte ratio; Preop, preoperative day; Op, operation day.