Comparison of clinical outcomes between emergency and elective right lobe living donor liver transplantation at a single center: A retrospective cohort study

Living donor liver transplantation (LDLT) is a critical treatment for both end-stage liver disease and acute liver failure. However, emergency LDLT (eLDLT) presents considerable challenges due to limited time for evaluation, hemodynamic instability, and elevated perioperative risks. This study aimed to compare clinical characteristics, surgical features, and early outcomes between emergency and elective LDLT, and to identify predictors of early postoperative mortality. A prospective-retrospective cohort study was conducted on 139 adult LDLT recipients from 2019 to 2022. Patients were categorized into elective LDLT (n = 91) and eLDLT (n = 48) groups. Preoperative data, intraoperative parameters, and postoperative outcomes were analyzed. Logistic regression was used to identify independent predictors of 30-day mortality. eLDLT recipients had significantly higher Model for End-Stage Liver Disease scores and worse liver-kidney function compared to elective cases. They experienced greater intraoperative blood loss, higher transfusion requirements, longer ICU stays, and a markedly higher 30-day mortality rate (18.7% vs 0%; P = .001). Common causes of early death included pneumonia, fungal infection, and graft failure. Late mortality and complication rates after 30 days did not differ significantly between groups. Preoperative lactate ≥ 4 mmol/L was independently associated with 30-day mortality (odds ratio = 18.46, 95% confidence interval: 3.00-113.73; P = .002). eLDLT is associated with significantly higher early mortality and perioperative complexity. Elevated preoperative serum lactate is a strong independent predictor of 30-day mortality and may serve as a valuable tool in perioperative risk assessment and decision-making in urgent transplantation scenarios.