Predicting risk factors for waiting mortality in adult emergent living donor liver transplantation based on Korean national data

Background: Emergency living donor liver transplantation (e-LDLT) is crucial for patients experiencing acute liver failure, acute-on-chronic liver failure, or severe, life-threatening cirrhosis.The purpose of this study was to determine the risk factors that affect the death rate of patients who are waiting for e-LDLT by analyzing data on the Korean Network for Organ Sharing (KONOS).Methods: A retrospective examination of KONOS data was performed, encompassing consecutive e-LDLT applications from 2017 to 2021.Exclusions were made for pediatric patients.The data were classified into two distinct groups.Patients who died before getting e-LDLT were classified as Group 1 (n=38), while patients who spontaneously recovered without liver transplantation, non-emergency LDLT, or deceased donor liver transplantation more than 14 days following e-LDLT treatment were classified as Group 2 (n=30).Results: Significantly greater rates of pre-transplant critical care unit stay, pre-transplant ventilator support, or continuous renal replacement treatment were observed in Group 1 compared to Group 2. In comparison to Group 2, Group 1 exhibited notably lower serum albumin levels and higher model for end-stage liver disease (MELD) scores.Significantly, the MELD score increased by more than 10% for 3 days preceding to e-LDLT applications in Group 1 compared to Group 2. The multivariate analysis revealed that the only factor that affected the death of patients waiting for LDLT after e-LDLT applications was pre-transplant ventilator support. Conclusion:The present study suggested that patients receiving mechanical ventilator support in the pre-transplant period should be approached cautiously when deciding on e-LDLT.