Early allograft dysfunction paradox: Is the increasing donor age and BMI a concern?

Abstract

Background: In recent years, there has been an increase in the use of graft from older donors and with higher BMI. There is a concern regarding the effect of this change in practice on the incidence of Early Allograft Dysfunction (EAD). Materials and Methods: Data regarding liver function, ischemic times, donor history and complications for all adults, elective, first liver transplant performed with whole grafts, in the last five years were extracted from a prospectively maintained database.EAD was defined according to Olthoff et al (bilirubin = 10mg/dL on day 7, INR = 1.6 on day 7, and ALT >2000 IU/L within the first 7 days). Results: 476 liver transplants met the criteria for this study; data analysis was performed for 100 transplants (77 DBDs, 23 DCDs) performed between September 2017 and 2018. Incidence of EAD was 30%, 24.7% in DBDs and 47.8% in DCDs (p=0.041).Donor BMI was significantly higher in the cases that developed EAD (28.6 vs 26.2, p=0.05) although this wasn't confirmed as significant risk factor in the univariate analysis. There was no significant difference in donor age between the 2 groups (47.1 vs 50.8, p=0.291) but a donor age above 61 years was a protective factor against the risk of EAD at the univariate analysis (p=0.032, RR=0.242).Other risk factors for EAD were, DCD graft (p=0.037, RR 2.798) and cold ischemia above 522 minutes (p=0.035, RR 3.185); while EAD increased the incidence of sepsis (p<0.001, RR=5.524), CVVH (p=0.022, RR= 3.879), graft loss (p=0.027, RR=6.8), recipient mortality (p=0.065, RR 5.231) and morbidity (p=0.08, RR 2.667). Conclusions: EAD can affect up to one third of liver transplant recipients and it can lead to sepsis, renal impairment and graft loss. More data are necessary to determine the role of donor age and BMI and other risk factors.