Risk factors for in-hospital postoperative complications and 6-month graft survival after liver transplantation: A multicenter cohort study

Liver transplantation (LT) is a high-risk surgery requiring costly hospital resources. Robust multicenter data on the incidence of postoperative complications and their risk factors remains very limited. The objectives of this study were to describe the incidence and variability of postoperative complications in adult LT recipients and identify their determinants. We conducted a cohort study that included consecutive LT recipients over at least one year between January 2021 and May 2023 in eight LT centers in Canada and France. Our primary outcome was 7-day early allograft dysfunction or primary graft non-function. Our secondary outcomes included acute kidney injury (AKI) and severe complications. We measured the incidence and variability of these outcomes and their association with potential preoperative determinants using multivariable models. We reported incidences and risk ratios (RR) with 95% confidence intervals (CI). We included 852 patients. The incidence of our primary outcome, AKI and severe complications was respectively 28% [95% CI, 25% to 31%], 50% [95% CI, 47% to 54%] and 59% [95% CI, 55% to 62%]. Most outcomes were variable across centers. The primary outcome was mostly determined by donor age, body mass index, static cold ischemia time and type of donation (RR from 0.64 to 1.21). Model for End-Stage liver disease (MELD) 3.0 score and preoperative requirement for organ support were important determinants of transfusions, AKI and severe complications. The incidence of most outcomes was variable across centers. In conclusion, postoperative complications, such as graft dysfunction, AKI and severe complications, were frequent after LT. We identified risk factors, such as donor and graft characteristics, MELD 3.0 and preoperative requirement for organ support, that may inform transplant risk evaluation.