Clinical relevance of peak serum transaminases after an elective liver transplantation

Abstract

Introduction: Serum transaminases are routinely monitored after liver transplantation (LT) to detect graft dysfunction. However, the role of peak-serum-transaminases (PST) on postoperative outcome is controversial. The aim of the present study was to determine whether PST was correlated early graft failure. Method: Between 2006 and 2014, 302 consecutive patients receiving a first elective liver transplant from brain-dead donor were enrolled in a single-center prospective database. Donor and recipient demographic data as well as perioperative data were recorded and retrospectively analyzed. PST was defined as the highest value of either aspartate (AST) or alanine (ALT) aminotransferase within the postoperative two days. Early graft failure was defined as death or need for retransplantation within 90-days. Multivariable analysis was performed using logistic regression models. Results: Twenty-six (8.6%) patients had graft failure, of whom 6 (23.1%) had PST >2000 UI/L. Only pre-transplant dialysis (IC 95% [1.797–24.447]; p = 0.005) and PST >2000 UI/L (IC 95% [1.484–19.130]; p = 0.010) were shown to be independent predictor of early graft failure. However the specificity and sensitivity of PST >2000 UI/L to predict early graft failure were respectively 23% and 92% and the area under the ROC curve was 0.577, indicating a low discrimination of this surrogate. Conclusion: PST is an independent predictor of early graft failure but failed to accurately detect patients who will need an early retransplantation.