Abstract
ABSTRACTObjective:To propose a grading system for early hepatic graft dysfunction.Methods:A retrospective study from a single transplant center. Recipients of liver transplants from deceased donors, transplanted under the MELD system were included. Early graft dysfunction was defined by Olthoff criteria. Multiple cut-off points of post-transplant laboratory tests were used to create a grading system for early graft dysfunction. The primary outcome was 6-months grafts survival.Results:The peak of aminotransferases during the first postoperative week correlated with graft loss. The recipients were divided into mild (aminotransferase peak >2,000IU/mL, but <3,000IU/mL); moderate (aminotransferase peak >3,000IU/mL); and severe (aminotransferase peak >3,000IU/mL + International Normalized Ratio ≥1.6 and/or bilirubin ≥ 10mg/dL in the 7th postoperative day) early allograft dysfunction. Moderate and severe early dysfunctions were independent risk factors for graft loss. Patients with mild early dysfunction presented with graft and patient survival comparable to those without graft dysfunction. However, those with moderate early graft dysfunction showed worse graft survival than those who had no graft dysfunction. Patients with severe early dysfunction had graft and patient survival rates worse than those of any other groups.Conclusion:Early graft dysfunction can be graded by a simple and reliable criteria based on the peak of aminotransferases during the first postoperative week. The severity of the early graft dysfunction is an independent risk factor for allograft loss. Patients with moderate early dysfunction showed worsening of graft survival. Recipients with severe dysfunction had a significantly worse prognosis for graft and patient survival.
Highlights
Advances in surgery, anesthesia, immunosuppression and medical care have contributed to the current success of liver transplantation across the globe[1]
To propose a grading system for early allograft dysfunction. This is a retrospective cohort study that was initially conducted by including data from all recipients of liver transplant performed at Hospital Israelita Albert Einstein (HIAE) from July 1st, 2005 through June 30th, 2010
primary non-function (PNF) was described according to the definition of the United Network for Organ Sharing (UNOS), within 7 days of implantation, as defined by aspartate aminotransferase (AST) ≥3,000 and one or both of the following: International Normalized Ratio (INR) ≥2.5 or acidosis, defined as having an arterial pH ≤7.30 or venous pH of 7.25 and/or lactate ≥4mMol/L(22)
Summary
Anesthesia, immunosuppression and medical care have contributed to the current success of liver transplantation across the globe[1]. There has been a growing interest in the development of benchmarks that correlate initial graft function and post-transplant outcomes[9,10,11,12,13]. Earlier single-center studies have tried to define EAD in the pre-Model for End-Stage Liver Disease (MELD)(14-17). Other terms such as “poor initial function” or “graft dysfunction with or without inclusion of primary non-function and vascular complications” have been proposed[12,13]. This criterion highly correlated with 6-month patient and graft survival[10]
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