Deceased Donor Liver Research Articles

Successful liver transplantation using a deceased donor liver with glycogenic hepatopathy

Background: Donor scarcity is one of the major problems in the development of a transplant program. Proper assessment of the donor liver is critical for successful liver transplantation to avoid unnecessary organ disposal as well as poor outcome.

Ventilator support in the pretransplant period predisposes early graft failure after deceased donor liver transplantation.

Deceased donor liver transplantation (DDLT) recipients in Korea are generally sicker due to an increasing organ shortage. In the present study, the risk factors for early 30-day liver graft failure after DDLT were identified. From August 2017 to February 2021, 265 adult DDLTs were performed. The characteristics of patients with and without 30-day graft failure were compared. Liver graft failure occurred in 11 patients (17.7%) after DDLT. Baseline and perioperative characteristics of donors and recipients were not statistically significantly different between the 2 groups. The cumulative graft and overall survival rates at 6 months were 83.9% and 88.7%, respectively. Multivariate analysis showed ventilator support in the pretransplant period was a predisposing factor for 30-day graft failure after DDLT. Present study indicates that cautious decision is required when allocating DDLT in critically ill patients on mechanical ventilatory support.

Predicted Impact of the Model for End-Stage Liver Disease 3.0 in a Region Suffering Severe Organ Shortage.

The model for end-stage liver disease 3.0 (MELD3.0) is expected to address the flaws of the current allocation system for deceased donor liver transplantation (DDLT). We aimed to validate MELD3.0 in the Korean population where living donor liver transplantation is predominant due to organ shortages. Korean large-volume single-centric waitlist data were merged with the Korean Network for Organ Sharing (KONOS) data. The 90-day mortality was compared between MELD and MELD3.0 using the C-index in 2,353 eligible patients registered for liver transplantation. Patient numbers and outcomes were compared based on changes in KONOS-MELD categorization using MELD3.0. Possible gains in MELD points and reduced waitlist mortality were analyzed. MELD3.0 performed better than MELD (C-index 0.893 for MELD3.0 vs. 0.889 for MELD). When stratified according to the KONOS-MELD categories, 15.9% of the total patients and 35.2% of the deceased patients were up-categorized using MELD3.0 versus MELD categories. The mean gain of MELD points was higher in women (2.6 ± 2.1) than men (2.1 ± 1.9, P < 0.001), and higher in patients with severe ascites (3.3 ± 1.8) than in controls (1.9 ± 1.8, P < 0.001); however, this trend was not significant when the MELD score was higher than 30. When the possible increase in DDLT chance was calculated via up-categorizing using MELD3.0, reducible waitlist mortality was 2.7%. MELD3.0 could predict better waitlist mortality than MELD; however, the merit for women and patients with severe ascites is uncertain, and reduced waitlist mortality from implementing MELD3.0 is limited in regions suffering from organ shortage, as in Korea.

The clinical outcomes of patients with vascular invasion after deceased donor liver transplantation.

Vascular invasion is a major risk factor for poor prognosis of liver transplantation (LT) for hepatocellular carcinoma (HCC), and this study aimed to evaluate the feasibility and efficacy of deceased donor LT (DDLT) for the treatment of microvascular invasion (MVI) and segmental portal vein tumor thrombus (PVTT). We retrospectively analyzed 141 patients who received DDLT for HCC combined with vascular invasion from January 2016 to December 2023 at Shulan (Hangzhou) Hospital. To assess the risk of vascular invasion associated with the LT prognosis, we evaluated various clinicopathologic variables. The recurrence-free survival (RFS) and overall survival (OS) based on different types of vascular invasion were also analyzed. A total of 141 patients were enrolled in this study, including patients with MVI (MVI group, n=60), segmental PVTT with segmental branches of the portal vein or above (segmental PVTT group, n=13), and lobar PVTT involving the left and right branches of the portal vein or the main portal vein (lobar PVTT group, n=68). Between the tumor recurrence group and the no recurrence group, there were significant differences in alpha-fetoprotein (AFP) level, tumor total diameter, pretransplant treatment, histological grade, and types of vascular invasion. Subgroup analyses were performed according to the types of vascular invasion, the lobar PVTT group had a significantly higher recurrence rate (lobar vs. MVI: 88.2% vs. 35.0%, lobar vs. segmental: 88.2% vs. 30.8%, both P<0.001), but there was no difference in recurrence rate between the MVI group and the segmental PVTT group (35.0% vs. 30.8%, P>0.99). The 3-year RFS rate and OS rate were as low as 9.1% and 45.9% in the lobar PVTT group, compared with 65.5% and 76.0% in the MVI group, 58.3% and 75.0% in the segmental PVTT group. Multivariate analysis showed that Child-Pugh classification, tumor total diameter, histological grade, and lobar PVTT were the main risk factors affecting RFS, whereas Child-Pugh classification, tumor total diameter, and lobar PVTT were the main risk factors affecting OS. Finally, analysis of the segmental PVTT group revealed that RFS was significantly higher in well and moderately-differentiated patients than in poor-differentiated patients (P=0.01). Lobar PVTT remains a contraindication to LT, whereas segmental PVTT can still be considered for LT after careful screening.

Neurological Complications after Deceased Donor Liver Transplant: A Case Series from a Public Sector Hospital

This is a case series of neurological complications which occurred after Deceased Donor Liver Transplant (DDLT) in a public sector hospital. The clinical presentations were bizarre. This is because patients with End Stage Liver Disease (ESLD) commonly have hepatic encephalopathy and postoperatively can present with similar clinical picture, like tremors and altered mentation. The first patient in the series presented with tremors due to Calcineurin Inhibitor (CNI) toxicity, second had Posterior Reversible Encephalopathy Syndrome (PRES), third with Osmotic Demyelination Syndrome (ODS) with coma and fourth with Extrapyramidal Syndrome (EPS). Patients 1 and 4 had involuntary movements and other clinical manifestations which interfered with recuperation in the postoperative period. So, the dosages of the immunosuppressants were adjusted and serum tacrolimus assay were serially monitored on alternate days. Case 3 developed PRES due to hypertension, as a result of high serum tacrolimus levels. The patient presented with headache and seizures, which if uncontrolled would have been lethal. In Case 4 clinical features and management of a patient who suffered prolonged coma due to ODS for about three months has been discussed. Also, the same patient had a cerebral infarct due to embolic phenomenon inspite of thromboprophylaxis. From this case series, it needs to be emphasised that postoperative occurrence of neurological complications are likely. So careful selection of the recipients, steady titration of immunosuppressants and watchful monitoring of the neurological signs are essential to improve the outcome of the transplant. Imaging of the brain, preferably Magnetic Resonance Imaging (MRI) should not be delayed to rule out other differential diagnosis.

Split Liver Transplantation: An Analytical Decision Support Model

Split liver transplantation (SLT) is a procedure that can potentially save two lives using one liver, thus increasing the total utility derived from the limited number of donated livers available. It also can potentially improve equity, by giving transplant candidates who are physically smaller (including children) increased access to liver transplants. However, SLT is rarely used in the US. To help quantify the benefits of increased utilization of SLT and provide decision support tools, we introduce a deceased-donor liver allocation model with both efficiency and fairness objectives. In this model we formulate a multi-queue fluid system, incorporating the specifics of donor-recipient size matching and patients’ dynamically changing Model for End-Stage Liver Disease scores. Leveraging a novel decomposition result we find the optimal matching, enabling us to benchmark the performance of different allocation policies. Numerical results, utilizing data from UNOS, show that SLT can significantly increase total quality-adjusted life years, reduce patient deaths, and improve fairness among different patient groups.

Donor-Recipient Body Surface Area Mismatch and the Outcome of Liver Transplantation in the UK.

Introduction: Too small or too big liver grafts for recipient's size has detrimental effects on transplant outcomes. Research Questions: The purpose was to correlate donor-recipient body surface area ratio or body surface area index with recipient survival, graft survival, hepatic artery or portal vein, or vena cava thrombosis. High and low body surface area index cut-off points were determined. Design: There were 11,245 adult recipients of first deceased donor whole liver-only grafts performed in the UK from January 2000 until June 2020. The transplants were grouped according to the body surface area index and compared to complications, graft and recipient survival. Results: The body surface area index ranged from 0.491 to 1.691 with a median of 0.988. The body surface area index > 1.3 was associated with a higher rate of portal vein thrombosis within the first 3 months (5.5%). This risk was higher than size-matched transplants (OR: 2.878, 95% CI: 1.292-6.409, P = 0.01). Overall graft survival was worse in transplants with body surface area index ≤ 0.85 (HR: 1.254, 95% CI: 1.051-1.497, P = 0.012) or body surface area index > 1.4 (HR: 3.704, 95% CI: 2.029-6.762, P < 0.001) than those with intermediate values. The graft survival rates were reduced by 2% for cases with body surface area index ≤ 0.85 but were decreased by 20% for cases with body surface area index > 1.4. These findings were confirmed by bootstrap internal validation. No statistically significant differences were detected for hepatic artery thrombosis, occlusion of hepatic veins/inferior vena cava or recipient survival. Conclusions: Donor-recipient size mismatch affects the rates of portal vein thrombosis within the first 3 months and overall graft survival in deceased-donor liver transplants.

Survival outcomes in adult recipients using pediatric deceased donor liver grafts. A PSM analysis from the OPTN/UNOS liver transplant registry

BackgroundThe use of pediatric donor grafts in adult recipients is a viable option to help address persistent organ shortages. Existing data is inconclusive regarding outcomes of pediatric-to-adult liver transplantation. Materials and methodsUsing the UNOS-STAR database, adults receiving a whole liver graft in the US between 2010 and 2019 were retrospectively identified. Patients were divided into two groups depending on whether they received a graft from a pediatric-donor (≤12y) or an adult-donor (≥18y). The groups were further matched using propensity-score matching (PSM) in a 1:1 ratio. Liver grafts disposition trends from pediatric donors ≤12y, as well as usage patterns of these grafts for adult recipients across UNOS regions were analyzed. The primary outcomes of this study were graft and patient survival. Secondary outcomes included LOS and need for re-transplantation. ResultsThere were 4,798 deceased donors ≤12 years during the study period. Of those, 3476 liver grafts were recovered for transplant, 203/3,476 were discarded and 3,273/3,476 transplanted. Twenty percent of those recipients were adults ≥18y. PSM created a cohort of 642 patients, (pediatric-donor group n = 321, adult-donor group n = 321). Survival analyses revealed no difference in graft survival (p = 0.64) or overall patient survival (p = 0.74) between pediatric-donor and adult-donor groups. Likewise, secondary outcomes were comparable between groups. Although not statistically significant, adults in the pediatric-donor group showed a trend toward higher rates of re-transplantation (4.4%) vs those in the adult-donor group (1.9%) (p = 0.07). A subgroup PSM analysis including only recipients with MELD score >18 further demonstrated comparable results including similar LOS, re-transplantation rates, graft failure (log-rank p-value = 0.57) and patient mortality (log rank p-value = 0.38). ConclusionPediatric-to-adult liver transplantation could represent a safe and effective option in the event that a pediatric graft is available and declined by all potential pediatric recipients, particularly if performed under careful patient selection, and in centers with pediatric liver transplant and/or LDLT. Our results are in favor of utilizing pediatric-donor livers in adult patients since there is no significant difference in mortality or graft survival and could potentially increase organ utilization by avoiding discard of these grafts.

Medical Assistance in Dying (MAiD) as a Source of Liver Grafts: Honouring the Ultimate Gift.

To report the clinical outcomes of liver transplants from donors after medical assistance in dying (MAiD) versus donors after cardiac death (DCD) and deceased brain death (DBD). In North America, the number of patients needing liver transplants exceeds the number of available donors. In 2016, MAiD was legalized in Canada. All patients undergoing deceased donor liver transplantation at Toronto General Hospital between 2016 and 2021 were included in the study. Recipient perioperative and postoperative variables and donor physiological variables were compared among 3 groups. Eight hundred seven patients underwent deceased donor liver transplantation during the study period, including DBD (n=719; 89%), DCD (n=77; 9.5%), and MAiD (n=11; 1.4%). The overall incidence of biliary complications was 6.9% (n=56), the most common being strictures (n=55;6.8%), highest among the MAiD recipients [5.8% (DBD) vs. 14.2% (DCD) vs. 18.2% (MAiD); P =0.008]. There was no significant difference in 1 year (98.4% vs. 96.4% vs. 100%) and 3-year (89.3% vs. 88.7% vs. 100%) ( P =0.56) patient survival among the 3 groups. The 1- and 3- year graft survival rates were comparable (96.2% vs. 95.2% vs. 100% and 92.5% vs. 91% vs. 100%; P =0.37). With expected physiological hemodynamic challenges among MAiD and DCD compared with DBD donors, a higher rate of biliary complications was observed in MAiD donors, with no significant difference noted in short-and long-term graft outcomes among the 3 groups. While ethical challenges persist, good initial results suggest that MAiD donors can be safely used in liver transplantation, with results comparable with other established forms of donation.

Technique of Hepatic Artery Anastomosis in Living Donor Liver Transplantation: Review of Its Results in Over 1200 Adult and Pediatric Transplants.

Failure to achieve a good arterial inflow to the graft in living donor liver transplantation (LDLT) has disastrous consequences to the graft and patient survival. Standard microvascular techniques of hepatic artery (HA) anastomosis used in deceased donor liver transplantation are not applicable in LDLT. We present the results of our unique Backwall-first technique of HA anastomosis in both adult and pediatric LDLT. Retrospective review of all consecutive patients who underwent LDLT from January 2010 to December 2020 was performed from our prospective database. Data with regard to early postoperative (90-day) hepatic arterial complications were analyzed. A total of 1276 LDLTs (876 adults, 400 children) were performed during the study period. In the 90-day postoperative period, HA anastomotic complications [thrombosis in 11 (0.9%); pseudoaneurysm in 3 (0.2%)] were observed in 14 recipients (1.1%) including 8 adults (0.9%) and 6 children (1.5%). Eight of these 14 recipients (0.6%) including 4 adults (0.5%) and 4 children (1%) had standard HA reconstruction. The remaining six (0.5%) including 4 adults and 2 children had complex arterial reconstruction with interposition graft and/or alternative arterial inflow. The Backwall-first technique of HA reconstruction described in this study achieved a very low HA complication rate in LDLT.

Calcification of the visceral aorta and celiac trunk is associated with renal and allograft outcomes after deceased donor liver transplantation

PurposeAtherosclerosis affects clinical outcomes in the setting of major surgery. Here we aimed to investigate the prognostic role of visceral aortic (VAC), extended visceral aortic (VAC+), and celiac artery calcification (CAC) in the assessment of short- and long-term outcomes following deceased donor orthotopic liver transplantation (OLT) in a western European cohort.MethodsWe retrospectively analyzed the data of 281 consecutive recipients who underwent OLT at a German university medical center (05/2010–03/2020). The parameters VAC, VAC+, or CAC were evaluated by preoperative computed tomography-based calcium quantification according to the Agatston score.ResultsSignificant VAC or CAC were associated with impaired postoperative renal function (p = 0.0016; p = 0.0211). Patients with VAC suffered more frequently from early allograft dysfunction (EAD) (38 vs 26%, p = 0.031), while CAC was associated with higher estimated procedural costs (p = 0.049). In the multivariate logistic regression analysis, VAC was identified as an independent predictor of EAD (2.387 OR, 1.290–4.418 CI, p = 0.006). Concerning long-term graft and patient survival, no significant difference was found, even though patients with calcification showed a tendency towards lower 5-year survival compared to those without (VAC: 65 vs 73%, p = 0.217; CAC: 52 vs 72%, p = 0.105). VAC+ failed to provide an additional prognostic value compared to VAC.ConclusionThis is the first clinical report to show the prognostic role of VAC/CAC in the setting of deceased donor OLT with a particular value in the perioperative phase. Further studies are warranted to validate these findings.Graphical abstractCT computed tomography, OLT orthotopic liver transplantation

Microsurgical replacement of the right hepatic artery with the donor superior mesenteric artery in cadaveric donor pediatric liver transplantation.

To present our experience of using the pediatric donor superior mesenteric artery (SMA) as the interpositioning vessel to reconstruct the hepatic artery in pediatric deceased donor liver transplantation. Pediatric patients who received pediatric deceased donor livers from December 2019 to June 2021 were enrolled. A total of 43 pediatric recipients received pediatric deceased donor livers during the study period. Thirty-four (79.1%) pediatric donors had normal hepatic artery anatomy, while nine (20.9%) showed variant anatomies. The SMAs of the pediatric donors were interposed in the latter eight cases. The anastomosis between the donor distal SMA and the donor celiac trunk artery (CTA) was initially performed in the back-table period, after which the other anastomosis between the donor proximal SMA and recipient CHA was performed. Only one case showed HAT occurrence (incidence rate, 2.3%). However, no arterial complications occurred in pediatric recipients with donor grafts that showed the variation of RHA replacement from the SMA and had undergone usage of the donor's SMA as an interpositioning vessel. In pediatric deceased donor liver transplantation, the use of SMA as an interpositioning medium can solve the problems related to a tiny caliber and anatomical variations of the donor hepatic artery.

Successful Case of Deceased Donor Liver Transplant for Polycystic Liver Disease

A 58-year-old woman was admitted to hospital for deceased donor liver transplant. Her liver volume, measured by computed tomography, had reached 22,764 cm3 and she was bedridden with performance status 3 because of abdominal distention. The Model for End-Stage Liver Disease score was 24 with exception points. The final weight of the removed liver after cystic fluid puncture was 14 kg. The patient recovered well after transplant and was discharged on postoperative day 43 with a weight of 41 kg and performance status of 1.

Hyperspectral Imaging for Viability Assessment of Human Liver Allografts During Normothermic Machine Perfusion.

Twenty-five deceased donor liver allografts were included in the study. During NMP, graft viability was assessed conventionally and by means of HSI. Images of liver parenchyma were acquired at 1, 2, and 4 h of NMP, and subsequently analyzed using a specialized HSI acquisition software to compute oxygen saturation, tissue hemoglobin index, near-infrared perfusion index, and tissue water index. To analyze the association between HSI parameters and perfusate lactate as well as perfusate pH, we performed simple linear regression analysis. Perfusate lactate at 1, 2, and 4 h NMP was 1.5 [0.3-8.1], 0.9 [0.3-2.8], and 0.9 [0.1-2.2] mmol/L. Perfusate pH at 1, 2, and 4 h NMP was 7.329 [7.013-7.510], 7.318 [7.081-7.472], and 7.265 [6.967-7.462], respectively. Oxygen saturation predicted perfusate lactate at 1 and 2 h NMP (R2 = 0.1577, P = 0.0493; R2 = 0.1831, P = 0.0329; respectively). Tissue hemoglobin index predicted perfusate lactate at 1, 2, and 4 h NMP (R2 = 0.1916, P = 0.0286; R2 = 0.2900, P = 0.0055; R2 = 0.2453, P = 0.0139; respectively). HSI may serve as a noninvasive tool for viability assessment during NMP. Further evaluation and validation of HSI parameters are warranted in larger sample sizes.

Ventilator support in pretransplant predisposes early graft failure after deceased donor liver transplantation

Ventilator support in pretransplant predisposes early graft failure after deceased donor liver transplantation

Deceased donor liver transplantation under Korean MELD score-based liver allocation system at a high-volume transplantation center

Deceased donor liver transplantation under Korean MELD score-based liver allocation system at a high-volume transplantation center

A study on differences in deceased donor liver transplantation before and after the introduction of the model for end-stage liver disease system: three low volume centers, multi-center trial

A study on differences in deceased donor liver transplantation before and after the introduction of the model for end-stage liver disease system: three low volume centers, multi-center trial

WAITING LIST FOR LIVER TRANSPLANTATION: CLINICAL AND ECONOMIC BURDEN.

Burden of disease is an indicator that relates to health status. United States and European epidemiological data have shown that the burden of chronic liver disease has increased significantly in recent decades. There are no studies evaluating the impact of complications of chronic liver disease on the waiting list for deceased donor liver transplantation (LTx). To determine the clinical and economic burden of complications of liver disease in wait-listed patients from the perspective of a transplant center. The study retrospectively analyzed medical records of 104 patients wait-listed for deceased donor LTx from October 2012 to May 2016 and whose treatment was fully provided at the study transplant center. Clinical data were obtained from electronic medical records, while economic data were collected from a hospital management software. To allocate all direct medical costs, two methods were used: full absorption costing and micro-costing. The most common complication was refractory ascites (20.2%), followed by portosystemic encephalopathy (12.5%). The mean number of admissions per patient was 1.37±3.42. Variceal hemorrhage was the complication with longest median length of stay (18 days), followed by hepatorenal syndrome (13.5 days). Hepatorenal syndrome was the costliest complication (mean cost of $3,565), followed by portosystemic encephalopathy ($2,576) and variceal hemorrhage ($1,530). The burden of chronic liver disease includes a great cost for health systems. In addition, it is likely to be even greater as a result of the insidious course of the disease.

Long-term outcomes of retransplantation after live donor liver transplantation: A Western experience

BackgroundDespite most liver transplants in North America being from deceased donors, the number of living donor liver transplants has increased over the last decade. Although outcomes of liver retransplantation after deceased donor liver transplantation have been widely published, outcomes of retransplant after living donor liver transplant need to be further elucidated. MethodWe aimed to compare waitlist outcomes and survival post-retransplant in recipients of initial living or deceased donor grafts. Adult liver recipients relisted at University Health Network between April 2000 and October 2020 were retrospectively identified and grouped according to their initial graft: living donor liver transplants or deceased donor liver transplant. A competing risk multivariable model evaluated the association between graft type at first transplant and outcomes after relisting. Survival after retransplant waitlisting (intention-to-treat) and after retransplant (per protocol) were also assessed. Multivariable Cox regression evaluated the effect of initial graft type on survival after retransplant. ResultsA total of 201 recipients were relisted (living donor liver transplants, n = 67; donor liver transplants, n = 134) and 114 underwent retransplant (living donor liver transplants, n = 48; deceased donor liver transplants, n = 66). The waitlist mortality with an initial living donor liver transplant was not significantly different (hazard ratio = 0.51; 95% confidence interval, 0.23–1.10; P = .08). Both unadjusted and adjusted graft loss risks were similar post-retransplant. The risk-adjusted overall intention-to-treat survival after relisting (hazard ratio = 0.76; 95% confidence interval, 0.44–1.32; P = .30) and per protocol survival after retransplant (hazard ratio:1.51; 95% confidence interval, 0.54–4.19; P = .40) were equivalent in those who initially received a living donor liver transplant. ConclusionPatients requiring relisting and retransplant after either living donor liver transplants or deceased donor liver transplantation experience similar waitlist and survival outcomes.

PSUN228 Incidence and Predictors of New Onset Diabetes After Transplant (NODAT) in Liver Transplant recipients.

Abstract Background NODAT (New onset Diabetes after Transplant) is associated with multiple complications in liver transplant recipients which has to be diagnosed and treated early to prevent graft failure, cardiovascular morbidity and mortality. With improvement in the care of liver transplant recipients, post-transplant survival has significantly increased. With improved survival, incidence of chronic rejection, Diabetes, Hypertension, Dyslipidemia, etc. complications incidence also increasing. Aims and Objectives To know the incidence and predictors of NODAT. Methodology This was a prospective study of non-Diabetic recipients who underwent Liver Transplantation at Yashoda Hospital, Secunderabad from January 2020 to May 2021. The follow-up duration was 6 months. Total 65 patients were enrolled after excluding recipients who were &amp;lt;18 years of age, were already having diabetes, whose survival was less than 6 months of transplantation and who were not of an Indian origin. All the relevant clinical and biochemical data were collected. Appropriate statistical tests were applied to compare NODAT and Non-diabetes groups (recipients who did not develop diabetes after liver transplantation) to know the predictors of NODAT. Diagnosis of NODAT was be established by the standard ADA guidelines using Fasting blood sugar (FBS), Post prandial blood sugar(PPBS) or HbA1C. Diagnosis of NODAT required the presence of one of the four parameters: (i) fasting blood glucose levels ≥ 126 mg/dL on two occasions OR (ii) Insulin therapy requirement for &amp;gt;= 30 days OR (iii) oral hypoglycemic agent use for ≥ 30 consecutive days OR (iv) HbA1c ≥ 6.5. Transient NODAT was defined as the resolution of hyperglycemia within 6 months of transplantation. Results Total incidence of NODAT in our study was 29.2%. Among them 47.36% were transient NODAT and 52.67% were persistent NODAT. Factors significantly associated with occurrence of NODAT were: Type of Transplant (Living donor liver transplant v/s Deceased donor liver transplant), Presence of Impaired fasting glucose (IFG), presence of post-operative hyperglycemia, lower pre-transplant Magnesium &amp; Immediate post-operative Magnesium level, lower post-operative Albumin, higher trough Tacrolimus level at 3 Months, higher Tacrolimus and steroid dose at 3 months. Factors for which association with NODAT could not be found were: Age, Hepatitis C cirrhosis, alcoholic cirrhosis, pre-transplant BMI, baseline MELD score, pre-transplant FBS, donor age, donor gender, donor BMI, donor FBS &amp; Hba1c, donor CT LAI (Liver Attenuation Index, L-S) value, Steroid dose at discharge, immediate post-op trough Tacrolimus level and use of Everolimus. CONCLUSION: NODAT is the significant entity to be addressed. A robust strategy should be in place for the screening of NODAT. Lower Magnesium levels, presence of pre-transplant IFG and post-operative hyperglycemia give an early opportunity for detection of NODAT. Minimizing Tacrolimus level and steroid dose could be an effective strategy for the prevention of NODAT. Presentation: Sunday, June 12, 2022 12:30 p.m. - 2:30 p.m.