The Relationship of Early Allograft Dysfunction with Complications and Resource Consumption after Liver Transplantation

Abstract

Introduction: Early allograft dysfunction (EAD) have been described as a risk factor for allograft loss. However, few attempts have been made to relate EAD with post-transplant complications and costs. We studied whether there is a relationship among EAD, post-transplant complications and resource consumption. Methods: This is a single center retrospective study. Included are primary isolated full liver grafts transplanted under the MELD system (n=281) from July 1st, 2005 through June 30th, 2010. Patients with primary non-function PNF and vascular complications leading to immediate transplantation were excluded from the study. EAD was defined as: peak of aminotransferases at the first week>2000 IU/mL, and/or INR≥1.6 at day 7, and/or BIL≥10 mg/dl at day 7. Patients were divided in groups according to the severity of EAD: no EAD (control), mild (aminotransferases>2000 and < 3000), moderate (aminotransferases>3000) and severe EAD (aminotransferases>3000IU/ml and INR>1.6 or Bilirubin>10). Main endpoint were post-transplant complications and resource consumption. Results: We found no differences in the donor and recipient characteristics among the groups. Patients with severe (10%) and moderate EAD (3.7%) had more vascular complications than those in the mild (0%) and no EAD groups (0%), P=0.03. There no differences in the rate of biliary and infectious complications among the groups. Patients with severe (80%) had more renal complications than those in the moderate EAD (48%), mild (55%) and no EAD groups (40%), P< 0.0001. Patients with severe EAD had longer transplant admissions (33.2 days) compared to those with moderade (19.6 days), mild (20,3 days) and no EAD (16.4 days), p=0.03. However, EAD did not impact re-admission rate and the number of re-admission days. EAD had also an impact on blood bank consumption. Those with severe and moderate EAD consumed more platelets, FFP and cryoprecipitate than patients with mild EAD or without EAD (p< 0.01). Conclusion: There is a relationship between EAD post-transplant complications and resource consumption. Patients with severe and moderate EAD had more vascular and renal and complications, stayed longer in the hospital and consume more blood bank resources.