Background: Potential indications for surgery frequently arise in patients awaiting
liver transplantation. There is a risk of hepatic decompensation and death triggered
by surgical trauma, but this has not been studied in detail in this unique population.
We aimed to quantify the impact of surgical interventions in patients awaiting liver
transplantation on hepatic function and identify risk factors for decompensation.
Methods: All surgeries between 2000 and 2018 in patients awaiting liver transplantation
in a highvolume German liver transplant center were analyzed retrospectively. Change
in liver function measured as indicated by MELD score was assessed and complication
rates recorded. The primary endpoint was a composite of an increase in MELD score
by > 5 points or death. A logistic regression model was used for multivariate analysis
to identify risk factors. Results: In total, 177 surgical procedures in 148 patients
were analyzed. The primary endpoint was reached in 42 cases (23.7%). The overall in-hospital
complication rate (including death) was 44.1%. Multivariate analysis identified elevated
leukocyte count, perioperative blood transfusion, preoperative presence of ascites,
and preoperative circulatory support as independent risk factors for a decline in
liver function or death. Conclusion: Surgery in patients awaiting liver transplantation
carries a relevant risk of hepatic decompensation and death that needs to be considered
when deciding whether to perform elective surgery prior to or defer until after liver
transplantation.
