Early Allograft Dysfunction Is Associated with Higher Complication Rate after Liver Transplantation

Abstract

Introduction: Liver transplantation is considered as the standard of care for patients with end-stage liver diseases. However, an early graft dysfunction (EAD) is still one of the many challenges that clinicians have to overcome. EAD has a varying incidence between 10.8% to 36.3% and the association between EAD and worse graft or patient survival rate has been repeatedly reported; however, little has been conducted about the postoperative complications after occurrence of EAD which lead subsequently to higher mortality among EAD patients. Method: We performed a retrospective analysis on patients who underwent liver transplantation from January 2007 to July 2012. For definition of EAD we adopted the Olthoff criteria. All complications were classified in accordance to the time-dependent occurrence as “early”, “intermediate” or “late”. Results: From a total of 555 patients, 214 (38.6%) developed EAD. Both 12 month graft and patient survival rate were significantly worse in EAD patients. Analysis of complications rate showed that EAD patients had higher rate of sepsis (p=0.001), acute renal failure (p<0.001) and bleeding postoperatively (p=0.012). EAD development was associated with higher likelihood for reoperation and retransplantation (p=0.04 and p<0.001). Within first week after transplantation, EAD patients had higher rate of sepsis and postoperative bleeding (p<0.001, p=0.015); however incidences of intermediate and late complications did not differ. Conclusions: Patients who develop EAD have significantly higher rate of early sepsis, postoperative bleeding and acute kidney injury, which constitute worse outcomes. Patients with EAD are more likely to have a reoperation and/or retransplantation.