Postoperative complications as a predictor for survival after liver transplantation - proposition of a prognostic score

Background: Liver transplantation is major surgery with a high risk of complications. Existing scoring systems for evaluating complications after surgery are not specific for liver transplantation. Nor are they designed to evaluate the relation to recipient survival or graft loss. We wished to uncover the relation between postoperative complications and one-year risk of death or retransplantation, and to develop a prognostic score for complications based on our findings. Method: The study was a retrospective cohort study including 253 adult liver recipients. Thirty-days postoperative complications were registered using the Clavien-Dindo classification. A prognostic score was developed based on types, severity, and quantity of complications. Results: A total of 1113 complications occurred in 233 (92.1 %) of the patients. One-year mortality or graft loss was associated with graft, biliary, surgical, systemic, pulmonary, cardiovascular, renal, and infectious complication but not with neurologic or gastrointestinal complications. The developed score was more accurate in predicting the outcome than both the modified Clavien-Dindo score and the Comprehensive Complication Index. Conclusion: Types, severity, and quantity of different postoperative complications after liver transplantation are not equally important. The proposed score may focus attention on treating or preventing complications with strong relation to recipient mortality or graft loss.