Retrospective Cohort Study
Copyright ©The Author(s) 2024.
World J Transplant. Mar 18, 2024; 14(1): 87752
Published online Mar 18, 2024. doi: 10.5500/wjt.v14.i1.87752
Table 1 Clinical characteristics of patients underwent liver transplantation
Patient demography
Total, n = 167 (100)
Pediatric, n = 47 (28.1)
Adult, n = 120 (71.8)
P value
Sex 0.492a
Male96 (57.5)25 (53.2)71 (59.7)
Female 71 (42.5)22 (46.8)49 (40.8)
Nationality< 0.001a
Bahraini152 (91.0)36 (76.6)116 (96.7)
Non-Bahraini15 (9.0)11 (23.4)4 (3.3)
Governorate0.369b
Northern73 (43.7)21 (44.7)52 (43.3)
Capital35 (20.9)6 (12.8)29 (24.2)
Southern34 (20.4)12 (25.5)22 (18.3)
Muharraq25 (15.0)8 (17.0)17 (14.2)
Age at transplant (yr)50.0 (14.9-58.4)3.7 (1.0-9.0)55.2 (48.4-60.5)< 0.001c
Weight at transplant (kg), (n = 83)52 (15.0-70.0)11.0 (7-23)69 (52-80)< 0.001c
Height at transplant (cm), (n = 75)163 (138-169)82.0 (69-120)167 (159-172)< 0.001c
Presence of associated diseases1130/162 (80.3)25 (53.2)105/115 (91.3)< 0.001a
Previous liver biopsy 67/145 (46.2)20/46 (43.5)47/99 (47.5)0.722a
Previous surgeries52/145 (35.9)17/46 (37.0)35/99 (35.4)0.855a
Kasai procedure11/145 (7.6)10/46 (21.7)1/99 (1.0)< 0.001a
Other surgeries45/145 (31.0)10/46 (21.7)35/99 (35.4)0.124a
Family history of liver disease38/145 (26.2)17/46 (37)21/99 (21.2)0.067a
Follow up duration (yr)6.5 (2.6-10.6)8.1 (1.3-10.6)6.1 (3.3-10.3)0.976c
Number of overseas visits3 (2.0-8.0)4 (2.0-10.0)3 (2.0-6.0)0.299c
Table 2 Indications of liver transplantation in pediatrics and adults in Bahrain
Indications of liver transplantationa
Total, n (%)
Pediatric indications47 (28.1)
Biliary atresia15 (31.9)
Progressive familial intrahepatic cholestasis9 (19.1)
Metabolic diseasesb7 (14.9)
Alagille’s syndrome3 (6.4)
Autoimmune hepatitis3 (6.4)
Primary sclerosing cholangitis3 (6.4)
Cystic fibrosis liver disease2 (4.3)
Hepatocellular carcinoma2 (4.3)
Cytomegalovirus hepatitis2 (4.3)
Othersc8 (17.0)
Adult indications120 (71.9)
Hepatitis C-related cirrhosis42 (35.0)
Nonalcoholic steatohepatitis19 (15.8)
Hepatocellular carcinoma18 (15.0)
Primary sclerosing cholangitis17 (14.2)
Hepatitis B virus15 (12.5)
Cryptogenic cirrhosis13 (10.8)
Autoimmune hepatitis9 (7.5)
Alcoholic liver cirrhosis4 (3.3)
Othersd5 (4.2)
Table 3 Donor-recipient relationship of patients underwent liver transplantation
Donor
Total LT, n = 150/173 (86.7)
Pediatrics, n = 48/49 (98.0)
Adults, n = 102/124 (82.3)
P value
Related living donors123 (82)44 (91.7)79 (76.5)0.041a
1st degree65 (52.8)29 (65.9)36 (45.6)0.020b
2nd degree19 (15.5)3 (6.8)16 (20.3)
3rd degree21 (17.1)10 (22.7)11 (13.9)
4th degree17 (13.8)2 (4.5)15 (18.9)
Unspecified relation1 (0.8)0 (0.0)1 (1.3)
Unrelated donors27 (18)4 (8.3)23 (22.5)0.041a
Living12 (8.0)3 (6.3)9 (8.8)0.753a
Cadaveric15 (10.0)1 (2.1)14 (13.7)0.038a
Table 4 Medications used after liver transplantation
Medicationsa
Total, n = 150/167 (89.8)
Pediatrics, n = 44/47 (93.6)
Adults, n = 106/120 (88.3)
P valueb
Immunosuppressive medications142 (94.7)40 (90.9)102 (96.2)0.234
Tacrolimus126 (84.0)38 (86.4)88 (83.0)0.807
Prednisolone76 (50.7)32 (72.7)44 (41.5)0.001
Mycophenolic acid73 (48.7)14 (31.8)59 (55.7)0.012
Cyclosporine A13 (8.7)4 (9.1)9 (8.5)1.000
Azathioprine8 (5.3)5 (11.4)3 (2.8)0.048
Everolimus7 (4.7)0 (0.0)7 (6.6)0.106
Baziliximab1 (0.7)1 (2.3)0 (0.0)0.293
Dietary supplementations109 (72.7)37 (84.1)72 (67.9)0.046
Calcium77 (51.3)18 (40.9)59 (55.7)0.110
Vitamin D63 (42.0)22 (50.0)41 (38.7)0.210
Magnesium35 (23.3)20 (45.5)15 (14.2)< 0.001
Multivitamin32 (21.3)27 (61.4)5 (4.7)< 0.001
Folic acid30 (20.0)14 (31.8)16 (15.1)0.026
Iron22 (14.7)11 (25.0)11 (10.4)0.040
Biotin4 (2.7)4 (9.1)0 (0.0)0.007
Carnitine2 (1.3)2 (4.5)0 (0.0)0.085
Antiviral (valganciclovir)23 (15.3)20 (45.5)3 (2.8)< 0.001
Antibiotics20 (13.3)18 (40.9)2 (1.9)< 0.001
Aminoglycosides15 (10.0)15 (34.1)0 (0.0)< 0.001
Co-trimoxazole12 (8.0)10 (22.7)2 (1.9)< 0.001
Antifungal medications9 (6.0)8 (18.2)1 (0.9)< 0.001
Fluconazole7 (4.7)6 (13.6)1 (0.9)0.003
Amphotericin B2 (1.3)2 (4.5)0 (0.0)0.085
Other medications135 (90.0)38 (86.4)97 (91.5)0.375
Proton pump inhibitors96 (64.0)21 (47.7)75 (70.8)0.009
Urosodeoxycholic acid91 (60.7)27 (61.4)64 (60.4)1.000
N-acetylcysteine66/118 (55.9)10/29 (34.5)56/89 (62.9)0.010
Aspirin57 (38.0)22 (50.0)35 (33.0)0.065
Table 5 Complications during or after liver transplantation
Complicationsa
Total, n = 93/149 (62.4)
Pediatrics, n = 33/46 (71.7)
Adults, n = 60/103 (58.3)
P valueb
Infection episodes58 (38.9)29 (63.0)29 (28.2)< 0.001
Tonsillitis 12 (8.1)10 (21.7)2 (1.9)< 0.001
Sepsis12 (8.1)3 (6.5)9 (8.7)0.755
Acute gastroenteritis11 (7.4)7 (15.2)4 (3.9)0.035
Cytomegalovirus7 (4.7)7 (15.2)0 (0.0)< 0.001
Fever of unclear cause7 (4.7)1 (2.2)6 (5.8)0.437
Pneumonia7 (4.7)5 (10.9)2 (1.9)0.029
Other infections131 (20.8)16 (34.8)15 (14.6)0.016
Biliary stricture 29 (19.5)5 (10.9)24 (23.3)0.115
Rejection15 (10.1)10 (21.7)5 (4.9)0.003
Early poor graft function9 (6.0)6 (13.0)3 (2.9)0.025
Incisional hernia9 (6.0)3 (6.5)6 (5.8)1.000
Surgical wound complications8 (5.4)2 (4.3)6 (5.8)1.000
Bleeding4 (2.7)2 (4.3)2 (1.9)0.587
Hepatic artery complications 2 (1.3)1 (2.2)1 (0.9)0.524
Portal vein thrombosis2 (1.3)1 (2.2)1 (0.9)0.524
Gastric perforation 2 (1.3)2 (4.3)0 (0.0)0.094
Chylous ascites2 (1.3)1 (2.2)1 (0.9)0.524
Other complications29 (6.0)3 (6.5)6 (5.6)1.000
Table 6 Analysis of outcome in pediatric and adult liver transplantation
Variable
Survived, n = 141 (84.4)
Died, n = 26 (15.6)
P value
Sex 0.130a
Male85 (60.3)11 (42.3)
Female56 (39.7)15 (57.7)
Nationality 0.471a
Bahraini127 (90.1)25 (96.2)
Non-Bahraini14 (9.9)1 (3.8)
Area of residency0.118b
Northern63 (44.7)10 (38.5)
Capital29 (20.6)6 (23.1)
Southern25 (17.7)9 (34.6)
Muharraq24 (17.0)1 (3.8)
Age at liver transplant (yr)48.8 (13.2-58.0)57.5 (47.9-65.2)0.019c
Age group 0.346a
Pediatric42 (29.8)5 (19.2)
Adult 99 (70.2)21 (80.8)
Weight at transplant (kg), (n = 83)52.0 (20.0-70.0)8.0 (5.0-46.0)0.144c
Height at transplant (cm), (n = 76)163.0 (149.0-169.0)138.0 (74.0-149.0)0.101c
Presence of associated diseases139 (98.6)23 (88.5)0.255a
Yes109 (78.4)21 (91.3)
No30 (21.6)2 (8.7)
Type of graft (n = 150)137 (97.2)13 (50.0)0.364a
Living122 (89.1)13 (100)
Cadaveric15 (10.9)0 (0.0)
Donor-recipient relationship (n = 150)137 (97.2)13 (50.0)0.704a
Related donors113 (82.5)10 (76.9)
Unrelated donors24 (17.5)3 (23.1)
Indications of liver transplantation
Hepatitis C virus37 (26.2)5 (19.2)0.623a
Primary sclerosing cholangitis18 (12.8)2 (7.7)0.743a
Nonalcoholic steatohepatitis15 (10.6)4 (15.4)0.503a
Hepatic cellular carcinoma14 (9.9)6 (23.1)0.092a
Biliary atresia13 (9.2)3 (11.5)0.718a
Hepatitis B virus13 (9.2)2 (7.7)1.000a
Autoimmune hepatitis11 (7.8)1 (3.8)0.694a
Metabolic diseases7 (5.0)0 (0.0)0.597a
Intra- or post-LT complications (n = 150)138 (97.9)11 (42.3)0.537a
Yes85 (61.6)8 (72.7)
No53 (38.4)3 (27.7)
Post-LT N-acetylcysteine use50/66 (75.8)46/52 (88.5)0.098
Liver transplant countries0.582b
Middle East 86 (61.0)19 (73.1)
Asia & Pacific 51 (36.2)8 (30.7)
Europe4 (2.8)0 (0.0)
North America 3 (2.1)0 (0.0)
Follow-up duration (yr)7.5 (3.9-10.6)1.5 (0.3-3.2)< 0.001c
Table 7 Univariate and multivariate analysis of the selected predictors of outcome of liver transplantation
VariableUnivariate analysis
Multivariate analysis
Odds ratio (95%CI)
P value
Odds ratio (95%CI)
P value
Male sex0.483 (0.207-1.128)0.0930.617 (0.127-2.999)0.549
Bahraini nationality 0.363 (0.046-2.886)0.3382.001 (0.124-32.414)0.625
Governorate (Northern vs others)0.774 (0.328-1.823)0.5580.912 (0.179-4.652)0.912
Age at LT (yr)0.980 (0.960-1.001)0.0591.047 (0.955-1.148)0.329
Age group (pediatrics vs adults)0.561 (0.198-1.588)0.2760.073 (0.001-8.750)0.284
Weight at LT (kg)1.009 (0.990-1.029)0.3621.047 (0.965-1.136)0.268
Height at LT (cm)1.007 (0.994-1.022)0.2931.000 (0.969-1.032)0.989
Presence of associated diseases0.346 (0.077-1.560)0.1671.131 (0.136-9.415)0.909
Related versus unrelated donor 1.865 (0.225-15.447)0.5631.979 (0.149-26.338)0.605
Hepatitis C virus1.494 (0.526-4.249)0.4510.275 (0.026-2.914)0.284
Biliary atresia0.779 (0.206-2.949)0.7131.474 (0.124-17.462)0.759
Presence of complications 0.601 (0.153-2.368)0.4670.222 (0.020-2.458)0.220
LT countries (Middle East versus others)2.096 (0.784-5.602)0.1402.699 (0.383-19.017)0.319