Identifying Predictors of Failure‐to‐Rescue after Liver Transplantation: A Multicenter Analysis of 1341 Patients

OBJECTIVE: To evaluate whether the difficulty of surgery affects failure-to-rescue (FTR) after liver transplantation (LT). SUMMARY BACKGROUND DATA: Predictors of FTR include both recipient and intraoperative factors, and their identification and improvement may reduce its incidence. METHODS: This retrospective study included all first-time isolated LTs performed in six centers. A difficult LT was defined as one in which the number of blood units transfused, cold ischemia time, and duration of surgery were all at or above the median values for the study population. FTR was defined as death within 90 days after a major postoperative complication. The correlations of a difficult LT with outcomes, including FTR, were assessed. Predictors of FTR were identified. RESULTS: The study population included 1341 patients. The respective incidences of difficult LT, 90-day major complications, 90-day mortality, and FTR were 17.4%, 53.6%, 5.8%, and 10.7%. Difficult LT was correlated with worse short-term outcomes, including a high FTR rate. Being in the intensive care unit, receiving renal replacement therapy at the time of LT, and difficult LT were independent predictors of FTR. CONCLUSIONS: Mortality following a difficult LT may be correlated to FTR. Identification of modifiable predictors of FTR may help to improve the post-transplant management of these patients.