Pretransplant predictors of early mortality of liver transplantation.

After nearly five decades of persistent exertion, liver transplantation (LT) has become a recognized and definite therapy with a highly successful outcome for various liver diseases, such as end-stage cirrhosis of the liver, acute liver failure, various metabolic diseases, and hepatic malignancy. The areas where major progress has been made, resulting in improvements in disease management, include refinements to surgical techniques, advances in critical care, and in particular, better immunosuppressive medication. Correspondingly, improved techniques for splitting the livers of deceased grafts and for carrying out live donor grafts have also played an important role over the past two decades in providing cures for many patients who have been waiting for LT from the deceased-donor waiting list. Many of these patients would have dropped off the list without these improvements. However, early mortality after LT still occurs even in the modern era. Identifying the predictors of early mortality after LT is an important issue that will allow the aggressive management of such potential events and help to minimize or even prevent these tragedies. The causes of early or 30-day mortality after LT are varied and should be classified into three categories: donor factors, recipient factors, and operative factors (Table 1). The particular type of LT, either deceased donor or living related donor, also has some impact on early mortality. In terms of donor factors, poor-quality or so-called marginal grafts from deceased donors, grafts that are small in size, and partial grafts with a complicated anatomy from live donors seem to cause primary nonfunction or severe dysfunction of the implanted graft, which then leads to graft failure and patient death. ABOincompatible grafts also show a higher rate of graft failure. In