Avaliação da mortalidade precoce em pacientes submetidos a transplante de fígado com enxertos captados em locais distantes do centro transplantador

Abstract

Liver transplantation is one of the most complex and effective interventions for treating end-stage liver disease, representing the only definitive therapeutic option for patients with irreversible liver failure. However, the shortage of available organs poses significant challenges, often requiring the procurement of grafts from distant locations. This practice may directly impact organ viability and clinical outcomes, particularly due to prolonged cold ischemia time (CIT). This study aims to evaluate early mortality (up to 15 days) in liver transplant recipients at Santa Casa de Belo Horizonte and analyze the clinical, demographic, and logistical factors influencing this outcome. This retrospective cohort study included 222 adult patients who underwent liver transplantation between March 2016 and November 2024. Variables analyzed included age, sex, pre-transplant diagnosis, MELD sodium, cold ischemia time, and geographic location of graft procurement. Grafts were categorized into three groups: those obtained within the Metropolitan Region of Belo Horizonte (n=107), from other cities in the state of Minas Gerais (n=99), and from other states (n=16). The total 15-day survival rate was 83.3%, while early mortality was 16.7% (n=37). Statistical analysis identified CIT >8 hours as an independent predictor of early mortality, reducing the chance of survival by 55% (OR=0.45; 95% CI: 0.22–0.92; p=0.026). Additionally, patients with MELD sodium ≥24 had a significantly higher risk of early death (OR=0.49; 95% CI: 0.24–0.99; p=0.046). The graft retrieval performed by a surgeon from another institution did not impact the outcomes. Despite the longer ischemia time observed in grafts obtained from more distant locations, no statistically significant difference was found in early mortality among the different retrieval groups (p=0.674). A higher incidence of young and male donors was observed in distant procurements. We conclude that the geographic origin of the graft, in itself, does not directly impact early mortality but serves as an indirect factor associated with prolonged CIT. The primary determinant of 15-day survival was recipient clinical severity, represented by MELD sodium, followed by cold ischemia time. Implementing strategies to optimize organ procurement logistics and reduce ischemia time, such as advanced preservation and transportation techniques, may improve liver transplant outcomes and increase patient survival. Keywords: Liver transplantation, cold ischemia time, early mortality, transplant logistics, organ procurement.