Intensive care unit readmission in adult Egyptian patients undergoing living donor liver transplant: A single-centre retrospective cohort study

doi:10.4254/wjh.v14.i6.1150

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World Journal of Hepatology

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

Retrospective Cohort Study

World J Hepatol. Jun 27, 2022; 14(6): 1150-1161
Published online Jun 27, 2022. doi: 10.4254/wjh.v14.i6.1150

Table 1 Causes of intensive care unit readmission (total N = 31 out of 299 patients)

	N	%
Sepsis	5	1.6
Pulmonary complications	3	0.9
Cardiovascular complications	3	0.9
HA thrombosis	3	0.9
7^Th day syndrome	1	0.3
Acute cellular rejection	1	0.3
Acute Pancreatitis	1	0.3
Cerebrovascular stroke	3	0.9
Graft failure	1	0.3
hemorrhagic shock	1	0.3
Liver infarction	1	0.3
Metabolic disorders	1	0.3
Portal vein thrombosis	1	0.3
Prograf neurotoxicity	2	0.6
PV STENOSIS	1	0.3
Re -transplant¹	2	0.6
Renal impairment	1	0.3

¹Re-transplantation for graft failure due to hepatic artery thrombosis in 1 case and small for size in the other case. HA: Hepatic artery; HV: Hepatic vein; LDLT: Living donor liver transplantation; N: Number; PV: Portal vein.

Table 2 Preoperative patients’ and donors’ characteristics (data were expressed as mean ± SD or number & percentage) (total N = 299)

		Total (N = 299), %		No ICU readmission (N = 268), %		ICU readmission (N = 31), %		Test statistic	P value
Age (years); mean ± SD (Range)		49.8 ± 8.6; (19.0 - 67.0)		49.4 ± 8.8; (19.0 - 67.0)		53.0 ± 5.1; (42.0 - 64.0)		3.381^a	0.001¹
Gender	Female	45	15.1	36	13.4	9	29.0	FE	0.032¹
Gender	Male	254	84.9	232	86.6	22	71.0	FE	0.032¹
BMI (Kg/m²); mean ± SD (Range)		28.4 ± 4.3; (18.5 - 52.9)		28.2 ± 4.0; (18.5 - 42.0)		29.4 ± 6.5; (20.6 - 52.9)		0.936^a	0.356
MELD score; Median [IQR] (Range)		16.0; [13.0 – 18.0] (6.0 - 29.0)		16.0; [13.0 -18.0] (6.0 - 29.0)		15.0; [12.0 – 20.0] (7.0 - 28.0)		0.538^b	0.590
Positive medical history		103	34.4	86	32.1	17	54.8	FE	1.000
	DM	79	26.4	66	24.6	13	41.9	4.282^c	0.039¹
	Hypertension	24	8.0	17	6.3	7	22.6	FE	0.006¹
	Bronchial asthma	3	1.0	2	0.7	1	3.2	FE	0.281
	IHD	4	1.3	4	1.5	0	0.0	FE	1.000
	Renal	2	0.7	0	0.0	2	6.5	FE	0.010¹
	Bilharziasis	2	0.7	2	0.7	0	0.0	FE	1.000
	Others	9	3.0	8	3.0	1	3.2	FE	1.000
Diagnosis	AIH	10	3.3	10	3.7	0	0.0	FE	0.606
	HCC	117	39.1	107	39.9	10	32.3	0.686^c	0.408
	PVT	37	12.4	34	12.7	3	9.7	FE	0.780
	Cryptogenic	32	10.7	29	10.8	3	9.7	FE	1.000
	ESLD	10	3.3	8	3.0	2	6.5	FE	0.278
	HCV	229	76.6	204	76.1	25	80.6	0.317^c	0.573
	HBV	11	3.7	11	4.1	0	0.0	FE	0.612
	BCS	2	0.7	2	0.7	0	0.0	FE	1.000
	PSC	2	0.7	2	0.7	0	0.0	FE	1.000
Encephalopathy		95	31.8	87	32.5	8	25.8	0.568^c	0.451
Creatinine clearance (mL/min); mean ± SD (Range)		88.7 ± 26.5; (10.0 - 172.0)		88.5 ± 25.8; (10.0 - 170.0)		90.4 ± 32.7; (16.0 - 172.0)		0.384^a	0.702
Serum creatinine (mg/dL); mean ± SD (Range)		0.97 ± 0.31; (0.30 - 2.40)		0.97 ± 0.32; (0.30 - 2.40)		0.96 ± 0.24; (0.50 - 1.30)		0.255^a	0.799
Serum Albumin gm/dL; mean ± SD (Range)		3.0 ± 0.5; (1.8 - 4.8)		3.0 ± 0.5; (1.8 - 4.8)		2.8 ± 0.5; (1.8 - 3.8)		1.428^a	0.154
Na mmol/L; mean ± SD (Range)		135.1 ± 5.2; (117.0 - 147.0)		135.1 ± 5.4; (117.0 - 147.0)		135.0 ± 3.6; (128.0 - 145.0)		0.137^a	0.891
Total bilirubin mg/dL; Median [IQR] (Range)		1.3; [0.8 - 1.9] (0.2 - 27.0)		1.3; [0.7 - 1.9] (0.2 - 27.0)		1.4; [1.1 - 1.9] (0.6 - 5.6)		1.270^b	0.204
Alkaline phosphatase IU/L; Median [IQR] (Range)		143.0; [97.0 - 221.0] (6.2 - 2369.0)		144.5; [97.0 - 231.5] (6.2 - 2369.0)		131.0; [98.0 - 167.0] (45.0 - 1410.0)		1.041^b	0.298
Donor age (years); mean ± SD (Range)		29.8 ± 6.3; (16.0 - 48.0)		30.0 ± 6.3; (16.0 - 48.0)		28.0 ± 5.9; (18.0 - 39.0)		1.731^a	0.084
Donor gender	Female	94	31.4	83	31.0%	11	35.5	0.263^c	0.608
Donor gender	Male	205	68.6	185	69.0%	20	64.5	0.263^c	0.608
Donor BMI (Kg/m²); mean ± SD (Range)		23.7 ± 2.6; (17.7 - 32.0)		23.8 ± 2.6; (17.7 - 32.0)		23.0 ± 2.3; (18.3 - 29.0)		1.545^a	0.124

^aIndependent samples T-test.

^bMann-Whitney test.

^cPearson’s Chi square test for independence.

¹Significant at P < 0.05. AIH: Autoimmune hepatitis; BMI: Body mass index; DM: Diabetes mellitus; FE: Fisher’s exact test; IQR: Interquartile range; N: Number; SD: Standard deviation; ICU: Intensive care unit; IHD: Ischemic heart disease; HCC: Hepatocellular carcinoma; PVT: Portal vein thrombosis; ESLD: End-stage liver disease; HCV: Hepatitis C virus; HBV: Hepatitis B virus; BCS: Budd-Chiari syndrome; PSC: Primary sclerosing cholangitis.

Table 3 Intraoperative and postoperative data of the studied patients (total N = 299)

		Total (N = 299), %		No ICU readmission (N = 268), %		ICU readmission (N = 31), %		Test statistic	P value
Waiting Time (days); Median [IQR] (Range)		86.0; [59.0 - 120.0] (20.0 - 546.0)		86.5; [56.5 - 120.0] (20.0 - 462.0)		74.0; [65.0 - 119.0] (29.0 - 546.0)		0.034^a	0.973
Warm ischemia time (min); mean ± SD (Range)		48.6 ± 19.4; (20.0 - 145.0)		48.7 ± 19.0; (20.0 - 145.0)		47.9 ± 22.7; (20.0 - 145.0)		0.222^b	0.274
Graft weight/GRWR; mean ± SD (Range)		1.06 ± 0.47; (0.01 - 6.30)		1.08 ± 0.49; (0.01 - 6.30)		0.98 ± 0.23; (0.01 - 1.30)		1.095^b	0.825
Cold ischemia time (min); Median [IQR] (Range)		45.0; [30.0 - 60.0] (10.0 - 180.0)		45.0; [31.0 - 60.0] (10.0 - 180.0)		45.0; [30.0 - 50.0] (20.0 - 125.0)		0.864^a	0.387
Packed red blood cells (units); Median [IQR] (Range)		4.0; [2.0 - 7.0] (1.0 - 28.0)		4.0; [2.0 - 7.0] (1.0 - 28.0)		3.0; [2.0 - 6.0] (1.0 - 17.0)		0.957^a	0.339
PV Anastomosis	RPV/MPV	255	85.3	230	85.8	25	80.6	FE	0.426
	RPV/CPV	34	11.4	29	10.8	5	16.1	FE	0.372
	RPV/RPV	4	1.3	4	1.5	0	0.0	FE	1.000
	LPV/LPV	1	0.3	1	0.4	0	0.0
	LPV/MPV	2	0.7	2	0.7	0	0.0
	RPH/CHV	2	0.7	2	0.7	0	0.0
	RPV/CBV	1	0.3	0	0.0	1	3.2
	RPV/CHV	1	0.3	1	0.4	0	0.0
HA Anastomosis	RHA/RHA	280	93.6	252	94.0	28	90.3	FE	0.708
	RHA/LHA	18	6.0	15	5.6	3	9.7	FE	0.606
	RHA/SPA	1	0.3	1	0.4	0	0.0
HVs Anastomosis	RHV/RHV	278	93.0	248	92.5	30	96.8	FE	0.708
	RHV/IVC	10	3.3	10	3.7	0	0.0	FE	0.606
	LMHV/LMHV	9	3.0	8	3.0	1	3.2	FE	1.000
	RHV/MHV	2	0.7	2	0.7	0	0.0
Synthetic graft		8	2.7	7	2.6	1	3.2	FE	0.588
Surgical vascular complications		47	15.7	39	14.6	8	25.8	FE	0.118
	HA stenosis	6	2.0	5	1.9	1	3.2
	HA thrombosis	24	8.0	19	7.1	5	16.1
	HV stenosis	3	1.0	3	1.1	0	0.0
	HVT	2	0.6	2	0.8	0	0.0
	PV stenosis	4	1.3	3	1.1	1	3.2
	PV thrombosis	7	2.3	6	2.2	1	3.2
	Sub-diaphragmatic hematoma	1	0.3	1	0.4	0	0.0

^aMann-Whitney test.

^bIndependent samples T-test. Significant at P < 0.05. FE: Fisher’s exact test; IQR: interquartile range; N: Number; SD: Standard deviation; GRWR: Graft to recipient weight ratio; HA: Hepatic artery; HV: Hepatic vein; PV: Portal vein; RPV: Right portal vein; MPV: Main portal vein; CPV: Common portal vein; LPV: Left portal vein; CHV: Central hepatic vein; RHA: Right hepatic artery; LHA: Left hepatic artery; SPA: Splenic artery; RHV: Right hepatic vein; IVC: Inferior vena cava; LMHV: Left and middle hepatic veins; MHV: Middle hepatic vein; HVT: Hepatic vein thrombosis; ICU: Intensive care unit.

Table 4 Outcome of the studied patients (total N = 299)

	Total (N = 299)		No ICU readmission (N = 268)		ICU readmission (N = 31)		Test statistic	P value
Initial Hospital length of stay (days); Median [IQR] (Range)	21.0; [18.0 - 26.0](1.0 - 150.0)		22.0; [19.0 - 26.0] (5.0 - 120.0)		3.0; [2.0 - 9.0] (1.0 - 150.0)		8.003^a	< 0.001¹
Length of stay in initial ICU (days); Median [IQR] (Range)	4.0; [3.0 - 5.0] (2.0 - 45.0)		4.0; [3.0 - 5.0] (2.0 - 45.0)		6.0; [5.0 - 7.0] (4.0 - 9.0)		6.676^a	< 0.001¹
Rejection (N, %)	36	12.0	34	12.7	2	6.5	FE	0.557
Mortality(N, %)	89	29.8	69	25.7	20	64.5	19.978^b	< 0.001¹

^aMann-Whitney test.

^bPearson’s Chi square test for independence.

¹Significant at P < 0.05. IQR: Interquartile range; N: Number; ICU: Intensive care unit.

Table 5 Logistic regression analysis for risk factors of intensive care unit readmission

	Wald	P value	OR	95%CI for OR
	Wald	P value	OR	Lower	Upper
Patients’ age (years)	4.707	0.030¹	1.048	1.005	1.094
Gender (male compared to female)	2.722	0.099	0.399	0.134	1.188
DM	1.257	0.262	1.828	0.637	5.244
Hypertension	0.462	0.497	1.641	0.394	6.842
Donors’ age (years)	1.700	0.192	0.954	0.888	1.024
Length of initial ICU stay (days)	1.255	0.263	1.055	0.960	1.159
Length of initial hospital stay (days)	37.306	< 0.001¹	0.836	0.789	0.885

¹Significant at P < 0.05. CI: Confidence interval; DM: Diabetes mellitus; OR: Odds ratio; ICU: Intensive care unit.

Citation: Salah M, Montasser IF, El Gendy HA, Korraa AA, Elewa GM, Dabbous H, Mahfouz HR, Abdelrahman M, Goda MH, Bahaa El-Din MM, El-Meteini M, Labib HA. Intensive care unit readmission in adult Egyptian patients undergoing living donor liver transplant: A single-centre retrospective cohort study. World J Hepatol 2022; 14(6): 1150-1161
URL: https://www.wjgnet.com/1948-5182/full/v14/i6/1150.htm
DOI: https://dx.doi.org/10.4254/wjh.v14.i6.1150