Prognostic Indicators and Risk Factors Associated With 30-Day Mortality After Liver Transplantation: A 13-Year Retrospective Cohort Study.

BACKGROUND: Early mortality following liver transplantation (LT) remains a critical challenge despite advancements in surgical techniques and immunosuppressive therapy. Timely identification of prognostic and risk factors is essential for improving postoperative outcomes. METHODS: We conducted a retrospective cohort study at a tertiary referral center in Taiwan, analyzing 1,436 adult LT recipients from 2010 to 2023. Early mortality was defined as death occurring within 30 days post-transplantation. Clinical variables, operative data, and post-transplant complications were compared between the early mortality group (n=16) and non-early mortality group (n = 1420). Multivariate logistic regression was used to identify independent risk factors. RESULTS: The 30-day mortality rate was 1.1%. Patients in the early mortality group had significantly higher Model for End-Stage Liver Disease scores (20.4 vs. 14.4, p = .001) and more frequently received deceased donor liver transplants (31.3% vs. 4.9%, p < .001). Multivariate analysis identified 4 independent risk factors for 30-day mortality following LT: deceased donor liver transplantation (Odds ratio [OR], 4.286), intraoperative blood loss per 1000 mL (OR, 1.062), catheter-related infection within 7 days (OR, 10.48), and graft failure or rejection (OR, 5.12). CONCLUSION: Our findings highlight several critical and potentially modifiable predictors of early mortality following LT. Vigilant perioperative management, infection prevention, and tailored donor-recipient strategies are essential to reducing 30-day mortality and improving transplant outcomes.