Preoperative and Immediate Postoperative Haematological and Biochemical changes following Deceased Donor Liver Transplantation A preliminary observation

BackgroundLiver transplantation often results in hemodynamic and biochemical changes in the immediate post operative period, often causing concern to the treating physician. Aim of the Study To study the preoperative clinical profile, the hematological and biochemical changes in the immediate post operative period (upto 7 days) following DDLT patients. MethodologyA detailed assessment of the patients pre operative clinical diagnosis, presence of co morbid illness, and post operative hematological, biochemical, and clinical events was made in the liver transplant recipients. Various parameters were analysed to understand the physiological changes that occurred in the transplanted liver and to detect complications in the early post operative period in DDLT patients.ResultsThere are totally 17 patients, categorised into Group 1 9 patients (survivors) and Group 2 8 patients (mortality). The Mean value of Hemoglobin was 12.4gdl. Early leucocytosis (12606 vs. 80751956), persistent azotemia (mean urea 122.2 in group II vs. 58.4 in group I) and a significant fall in platelet count (47501group II vs. 2, 21,222 in group I) were the causes of early mortality and morbidity. Transaminases showed a significant rise between the 2nd and 3rd post operative days (AST 764 vs. 1317 IU and ALT 478 vs. 685 IU) and stabilized and showed a downward trend by the 7th to 9th post operative days (28 vs. 51 AST and 44 vs. 91 ALT) in both group of patients, indicates successful engraftment and functioning graft. Prothrombin time and INR also showed the same trend. Acute increase in transaminases (4000) was seen in one patient with hepatic artery thrombosis. Cause of death was intraoperative events like cardiac arrhythmias and ischaemic cardiac events (2), pulmonary thromboembolism (one), and hepatic artery thrombosis (1), sepsis and multi organ failure (4). Two patients required renal replacement therapy for resistant renal failure. Conclusion In ouseries, preoperative co-morbid illness, post operative worsening azotemia, persistent coagulopathy, leucocytosis and sepsis, and cardiac events in the immediate post operative period were responsible for poor outcome in post Deceased Donor Liver Transplantation. Improvement in the liver function tests showed successful engraftment and functioning liver.