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Chinese Archives of General Surgery(Electronic Edition) ›› 2026, Vol. 20 ›› Issue (03): 150-156. doi: 10.3877/cma.j.issn.1674-0793.2026.03.002

• Original Article • Previous Articles    

Analysis of risk factors for early mortality after orthotopic liver transplantation

Xun Liu1, Liang Bi1, Ren Lang2, Anshi Wu1,()   

  1. 1 Department of Anesthesiology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing 100020, China
    2 Devision of Hepatobiliary and Pancreaticospleen Surgery, Beijing Chao-Yang Hospital, Capital Medical University, Beijing 100020, China
  • Received:2026-02-06 Online:2026-06-01 Published:2026-07-10
  • Contact: Anshi Wu

Abstract:

Objective

To explore the potential risk factors for mortality within 30 days after orthotopic liver transplantation (OLT) and provide scientific basis for formulating individualized perioperative intervention strategies and predicting postoperative risks.

Methods

This retrospective study included recipients who underwent OLT at Beijing Chao-Yang Hospital, Capital Medical University. Death within 30 days after surgery was defined as early postoperative mortality, and patients were grouped accordingly. General patient information, preoperative laboratory indicators, and intraoperative data were collected. Receiver operating characteristic (ROC) curves were used to determine the optimal cutoff values for each indicator. Least absolute shrinkage and selection operator (LASSO) regression was applied to screen factors relevant to early postoperative mortality, followed by univariate and multivariate Logistic regression analysis to identify independent risk factors. Restricted cubic spline (RCS) analysis was employed to examine the dose-response relationships between these factors and the risk of early mortality.

Results

A total of 535 OLT recipients were included, among whom 36 (6.7%) experienced early postoperative mortality. Multivariate Logistic regression analysis revealed that intraoperative erythrocyte transfusion >1 650 ml (OR=3.313, 95% CI: 1.397-7.857), intraoperative urine volume≤1 115 ml (OR=3.245, 95% CI: 1.409-7.473), preoperative platelet count≤24.5×109/L (OR=3.437, 95% CI: 1.194-9.895), and preoperative blood glucose≤4.8 mmol/L (OR=2.955, 95% CI: 1.286-6.791) were independent risk factors for early postoperative mortality after OLT. RCS analysis indicated that intraoperative erythrocyte transfusion volume and urine volume showed linear correlations with the risk of early postoperative mortality, while preoperative platelet count exhibited a nonlinear correlation with the risk of early postoperative mortality.

Conclusions

Low preoperative platelet count, preoperative hypoglycemia, high intraoperative erythrocyte transfusion volume, and low intraoperative urine volume are independent risk factors for early postoperative mortality. Preoperative measures should be taken to increase platelet counts above 24.5×109/L, while the optimal range for perioperative blood glucose requires further clarification.

Key words: Liver transplantation, Early mortality, Risk factors, Platelet count, Preoperative blood glucose, Erythrocyte transfusion volume, Intraoperative urine output

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