Poor Early Graft Function Research Articles

Implantation Warm Ischemia Time in Kidney Transplant Recipients: Defining Its Limits and Impact on Early Graft Function.

BackgroundProlonged cold ischemia is an established risk factor for poor early graft function (EGF). However, warm ischemia incurring during graft implantation has received little attention regarding its possible detrimental effect on EGF. The aim of our study was to examine the impact of recipient warm ischemia time on EGF.Material/MethodsThe data of 102 consecutive kidney transplants were analyzed to determine the association between duration of graft implantation time (IT) and EGF. Recipient IT groups were (GI) up to 45 min, (GII) 45–60 min, and (GIII) >60 min. EGF was categorized as immediate (IGF), slow (SGF), or delayed graft function (DGF). In recipients with IGF, graft function was further assessed by time needed for reduction in serum creatinine by 50% (SC50) of pre-transplant value, and serum creatinine on day 7 (SCD7).ResultsOf a total of 102 recipients, 55 (55%) were in GI, 33 (32%) were in GII, and 14 (13%) were in GIII. Factors prolonging IT were recipient body mass index (BMI) (p=0.02) and multiple arteries in donor kidneys (p<0.01). No recipients in GI had DGF or SGF, while 2 in GII had DGF, and 5 patients in GIII had poor EGF. SC50 was significantly longer in GIII and GII versus GI (40.8±42.4 and 32.8±20.4 vs. 22.2±17.2 [p=.02, p≤.01]), respectively. Mean SCD7 was also significantly higher in GIII and GII versus GI. The mean last serum creatinine was comparable among all groups.ConclusionsIT of more than 45 min was a risk factor for poor EGF, but achieved statistical significance only when it exceeded 60 min. Longer IT also significantly slowed the fall in SC50, and led to a higher SCD7. However, poor EGF and suboptimal early SC trends had little long-term effect on serum creatinine.

Sirtuin 1 attenuates inflammation and hepatocellular damage in liver transplant ischemia/Reperfusion: From mouse to human.

Hepatic ischemia/reperfusion injury (IRI), an inevitable antigen-independent inflammation response in cadaveric liver transplantation, correlates with poor early graft function, rejection episodes, and contributes to donor organ shortage. Sirtuin 1 (SIRT1) is a histone deacetylase that may regulate inflammatory cell activity and manage liver function in IRI, though its functional role and clinical relevance remains to be elucidated. We investigated the efficacy of SIRT1 activation in a murine liver IRI model and verified the concept of putative SIRT1-mediated hepatoprotection in clinical liver transplantation. In the experimental arm, mice were subjected to 90 minutes of liver partial warm ischemia followed by 6 hours of reperfusion with or without adjunctive SIRT1 activation in vivo (resveratrol [Res]). In parallel, bone marrow-derived macrophage (BMDM) or spleen lymphocyte cultures were treated with Res. In the clinical arm, liver biopsies from 21 adult primary liver transplant patients (2 hours after reperfusion) were divided into "low" (n = 11) versus "high" (n = 10) SIRT1 expression groups, assessed by Western blots. Treatment with Res attenuated murine liver IRI while up-regulating SIRT1, suppressing leukocyte infiltration, and decreasing proinflammatory cytokine programs. SIRT1 silencing (small interfering RNA) in BMDM cultures enhanced inflammatory cytokine programs, whereas addition of Res decreased proinflammatory response in a SIRT1-dependent manner. In addition, Res decreased interferon γ production in liver-infiltrating and spleen lymphocyte cultures. Human liver transplants with high SIRT1 levels showed improved hepatocellular function and superior survival (P = 0.04), accompanied by lower proinflammatory cytokine profile. In conclusion, our translational study is the first to identify SIRT1 as a regulator of hepatocellular function in human liver transplant recipients under ischemia/reperfusion stress. By targeting innate and adaptive immune activation, manipulation of SIRT1 signaling should be considered as a novel means to combat inflammation in liver transplantation. Liver Transplantation 23 1282-1293 2017 AASLD.

Prolonged post-reperfusion syndrome during multivisceral organ transplantation in a pediatric patient: a case report.

Multivisceral organ transplantation involves the transplantation of three or more abdominal organs, including small bowel, duodenum, stomach, liver, pancreas, colon, and so on. The large amounts of cold and acidic loading into systemic circulation from the graft during multivisceral organ transplantation may result in severe post-reperfusion syndrome (PRS). We describe here a 6-year-old pediatric patient with chronic intestinal pseudo-obstruction who experienced prolonged PRS and severe metabolic acidosis during seven abdominal organ transplantation including the liver, spleen, stomach, duodenum, small bowel, colon and pancreas. The hypotensive period lasted approximately 10 minutes after graft reperfusion and was accompanied by severe metabolic acidosis and hypothermia. Since PRS can be easily associated with adverse outcomes, such as poor early graft function and primary non-function, not only meticulous surveillance for aggravating factors for PRS but also their immediate correction were necessary in managing a pediatric patient undergoing multivisceral organ transplantation.

Is Warm Ischemia Not a Risk Factor for Delayed Graft Function in a Living-Donor Kidney Transplant?

The association between prolonged donor warm ischemia time and poor early graft function has been challenged, but with little evidence. We intend to remove ambiguities and present evidence from the current literature. All donor surgeons must strive to limit warm ischemia to reduce poor early graft function and improve long-term outcomes.

Prevention of Poor Early Graft Function Using Open Nephrectomy, and Minimizing the Risk of Procedure-Related Factors

Prevention of Poor Early Graft Function Using Open Nephrectomy, and Minimizing the Risk of Procedure-Related Factors

Delayed graft function in living donor kidney transplantation

Dear Editor,This paper [1] made interesting reading but con-tains several contradictions which need to be discussed.The glaring issue is the confusion about the de ni-tion of delayed graft function (DGF). In materials and methods, the authors de ne DGF as the need for dialysis (HD) in the rst week after transplan-tation, which would then be expected to be the cri-terion for diagnosis of DGF throughout the study. However, in the background section, the same def-inition is termed “the older de nition”, and that it was subjective and not standardized. Importantly, the de nition of DGF used in the results section to calculate its incidence is also different, because it included recipients who did not require HD. Eleven of their 68 recipients (16%) were labeled DGF, but of whom, only 3 (4%) required dialysis? The remaining 8 recipients labeled DGF did not re-quire dialysis and should correctly be labeled slow graft function (SGF), although the day 5 serum cre-atinine is not available [2]. The authors did quote this paper on SGF but failed to recognize its rele-vance of SGF to their own study [2]. The DGF g-ure of 16% quoted by the authors is perhaps the incidence of the combined DGF and SGF, which is comparable to the incidence of poor early graft function in the other series [3–5]. The confusion about the de nition is also present in discussion, and the vital question the authors failed to address was exactly how they de ned DGF? This inconsist-ency in de ning DGF puts a question mark over the ndings of the entire study.

Slow Early Graft Function: A Neglected Entity after Renal Transplantation

Background: After renal transplantation, early graft function (EGF) can be divided into delayed graft function (DGF), slow graft function (SGF) and immediate graft function (IGF). DGF is well documented. However, when evaluating the long-term significance of early function, the literature shows conflicting definitions and inconsistent results. In addition, SGF, a new entity separate to DGF and IGF, is a recent and poorly understood development. Aim: To investigate the risk factors for and the impact of poor EGF (PEGF) on long-term outcome. Methods: This retrospective study reviewed the records of local adult patients who underwent renal transplantation at the Groote Schuur Hospital (Cape Town, South Africa) between 2004 and 2008. EGF was divided according to day 5 serum creatinine into IGF (serum creatinine <150 µmol/l), SGF (serum creatinine >150 but <450 µmol/l) and DGF (serum creatinine >450 µmol/l or dialysis in the first week). DGF and SGF together comprised PEGF, with IGF alone representing good EGF (GEGF). Results: A total of 121 patients (77 men, 44 women; mean age 39 years, range 14–67) were included in the study. Eighteen were excluded due to nephrectomy (n = 8), death (n = 6) or loss to follow-up (n = 4) within the first year. Analysis of cadaveric donors showed no significant risk factors for PEGF with the exception of cold ischaemic time, which differed significantly between the GEGF and PEGF groups, with means of 12 and 16 h, respectively (p = 0.013). Considering both living and cadaveric grafts, the 1-year estimated glomerular filtration rate (eGFR) was significantly different between IGF and DGF (p = 0.038) as well as between IGF and SGF (p = 0.028), with no significant difference between SGF and DGF (p > 0.05). A comparison of the PEGF and GEGF groups yielded significantly different 1-year eGFR values (60 and 50 ml/min, respectively; p = 0.07), with PEGF also associated with a longer hospital stay (20 vs. 14 days; p = 0.00005). Acute rejection was independently associated with a lower 1-year eGFR (p = 0.028), but in the absence of rejection, GEGF and PEGF remained significantly different with regards to 1-year eGFR (p = 0.024). Conclusions: SGF is not related to IGF but rather to DGF and should thus be regarded as a form of PEGF as opposed to GEGF. PEGF has a worse long-term outcome, and this indicates the need for increased efforts in its prevention and greater attention to its management.

Early outcomes of laparoscopic donor nephrectomy with multiple renal arteries

We evaluated our experience with laparoscopic donor nephrectomy in patients with multiple renal arteries, comparing operative outcomes and early graft function with patients with a single renal artery. From January 2003 to February 2009, 130 patients underwent laparoscopic donor nephrectomy at our institution, 108 (83 %) with a single renal artery and 22 (17 %) with multiple arteries. Donor and recipient outcomes for single artery and multiple arteries allografts were compared. The LDN operative time was similar between the single artery and multiple arteries groups (162 vs 163 min, respectively, p = 0.87). Allografts with multiple arteries had significantly longer warm ischemia time (3.9 vs 4.9 min, p = 0.05) and cold ischemia time (72 vs 94 min, p < 0.001) than those with single artery. The conversion rate was similar between single and multiple arteries groups (6 % vs 4.5 %, respectively, p = 0.7). Multiple arteries grafts had a non statistically significant higher rate of poor graft function when compared to single artery grafts (23 % vs 12 %, respectively, p = 0.18). Five patients in the single artery group (4.6 %) and one patient in the multiple arteries group (4.5 %) needed dialysis during the first postoperative week. Overall, recipient complication rates were similar between single and multiple arteries groups (12.9 % vs 18.1 %, respectively, p = 0.51). Laparoscopic donor nephrectomy with multiple arteries was associated with a non statistically significant higher rate of poor early graft function. The procedure appears to be safe in patients with multiple arteries, with similar complications rates. Multiple arteries should not be a contraindication for laparoscopic donor nephrectomy.

Deleterious Influence of Prolonged Warm Ischemia in Living Donor Kidney Transplantation

BackgroundRecent studies investigating early graft function (EGF) after living donor kidney transplantation (LDKT) identified prolonged warm ischemia time (WIT) as a risk factor for the occurrence of poor EGF. The latter is associated with long-term graft loss; therefore the question arises whether prolonged WIT affects long-term outcomes in LDKT. MethodsData were collected on 472 consecutive adult LDKTs. Patients were divided according to the total WIT into 3 groups with short (<30 minutes), intermediate (30–45 minutes), or prolonged (>45 minutes) WIT. ResultsOf all patients, 193 (40.9%) experienced short, 249 (52.8%) intermediate, and 30 (6.4%) prolonged WIT. Prolonged WIT was a significant risk factor for the occurrence of poor EGF with an adjusted odds ratio of 4.252 (95% confidence interval [CI), 1.914 −9.447). Long-term graft survival was impaired in patients with prolonged WIT, with an adjusted hazard ratio of 3.163 (95% CI, 1.202–8.321). Multivariate analysis revealed determinants of prolonged WIT, including laparoscopic procurement, recipient overweight, right donor kidney, and multiple renal arteries. ConclusionProlonged WIT impairs long-term graft survival in LDKT. This finding underlines the need to develop strategies to avoid the occurrence of prolonged WIT in LDKT.

Poor early graft function impairs long-term outcome in living donor kidney transplantation

BackgroundPoor early graft function (EGF) after living donor kidney transplantation (LDKT) has been found to decrease rejection-free graft survival rates. However, its influence on long-term graft survival remains inconclusive.MethodsData were collected on 472 adult LDKTs performed between July 1996 and February 2010. Poor EGF was defined as the occurrence of delayed or slow graft function. Slow function was defined as serum creatinine above 3.0 mg/dL at postoperative day 5 without dialysis.ResultsThe incidence of slow and delayed graft function was 9.3 and 4.4%, respectively. Recipient overweight, pretransplant dialysis and warm ischemia were identified as risk factors for the occurrence of poor EGF. The rejection-free survival was worse for poor EGF as compared to immediate graft function with an adjusted hazard ratio (HR) of 6.189 (95% CI 4.075–9.399; p < 0.001). Long-term graft survival was impaired in the poor EGF group with an adjusted HR of 4.206 (95% CI 1.839–9.621; p = 0.001).ConclusionsPoor EGF occurs in 13.7% of living donor kidney allograft recipients. Both, rejection-free and long-term graft survivals are significantly lower in patients with poor EGF as compared to patients with immediate graft function. These results underline the clinical relevance of poor EGF as phenomenon after LDKT.

Renal Vein Lengthening Using Gonadal Vein Reduces Surgical Difficulty in Living‐Donor Kidney Transplantation

During living-donor kidney transplantation, to maximally decrease donor injury, the right kidney with lower glomerular filtration rate often is selected as the donor kidney. However, the renal vein of the right kidney is relatively short for transplantation. The gonadal vein is essentially useless and is easily accessed during the donor nephrectomy. Seventeen live kidney donors received right kidney nephrectomy for living-donor kidney transplantation. Short renal veins were lengthened by circular anastomosis or spiral anastomosis of longitudinally cut gonadal veins. The renal function of receivers was evaluated using creatinine clearance. The renal veins were extended by 2.0-2.7 cm with circular anastomosis and 4.1-4.5 cm with spiral anastomosis with an average of 2.5 ± 0.7 cm. Lengthening of renal veins averaged 20.4 ± 4.2 min. All surgeries were successful, significantly reducing difficulty of vascular anastomosis during transplantation. No poor early graft function occurred. No side effects were observed in donors. When donor renal veins are too short for effective kidney transplantation and may affect reliability of vascular anastomosis, they can be lengthened by using gonadal veins without increasing injury to the donor. Successful extension of donor kidney renal veins expands the indication for right donor kidneys.

RPSGL-Ig for Improvement of Early Liver Allograft Function: A Double-Blind, Placebo-Controlled, Single-Center Phase II Study†

The selectin antagonist known as recombinant P-selectin glycoprotein ligand IgG (rPSGL-Ig) blocks leukocyte adhesion and protects against transplantation ischemia reperfusion injury (IRI) in animal models. This randomized (1:1) single-center double-blind 47-patient phase 2 study with 6-month follow-up assessed rPSGL-Ig's safety and impact on early graft function at 1 mg/kg systemic dose with pretransplant allograft ex vivo treatment in deceased-donor liver transplant recipients. Safety was assessed in all patients, whereas efficacy was assessed in a prospectively defined per-protocol patient set (PP) by peak serum transaminase (TA) and bilirubin values, and normalization thereof. In PP patients, the incidence of poor early graft function (defined as peak TA >2500 U/L or bilirubin >10 mg/dL), average peak liver enzymes and bilirubin, normalization thereof and duration of primary and total hospitalization trended consistently lower in the rPSGL-Ig group compared to placebo. In patients with donor risk index above study-average, normalization of aspartate aminotransferase was significantly improved in the rPSGL-Ig group (p < 0.03). rPSGL-Ig treatment blunted postreperfusion induction versus placebo of IRI biomarker IP-10 (p < 0.1) and augmented cytoprotective IL-10 (p < 0.05). This is the first clinical trial of an adhesion molecule antagonist to demonstrate a beneficial effect on liver transplantation IRI and supported by therapeutic modulation of two hepatic IRI biomarkers.

Influence of Early Graft Function After Renal Transplantation and Its Impact on Long-Term Graft and Patient Survival

Objective To determine whether early graft function after transplantation impacted graft and patient survivals. Materials and methods Between 1981 and 2008, we performed 1308 renal transplantations. Poor early graft function was defined as a Cockroft-Gault glomerular filtration rate < 60 mL/min or less at 1 and 3 months posttransplant. Patients who lost their kidney or died within the first 12 months after transplantation were excluded from the study. Multivariate statistical analysis used Cox proportional hazards models. Results Of the 1308 patients 994 (78.8%) displayed poor early graft function at 1 month after transplantation (glomerular filtration rate < 60 mL/min), while 268 (21.2%) showed normal function (glomerular filtration rate ≥ 60 mL/min). The 2- and 6-year graft survival rates among the poor early graft function group were 96.8% and 85.8%, respectively, while those among the control group were 97.0% and 88.3%, respectively. The 2- and 6-year patient survival rates in the poor early graft function were 98.5% and 89.8% versus 98.9% and 96.3% in the control group. Similar results were observed at 3 months posttransplant. Controlling for patient age, donor age, HLA-AB and -DR mismatches, cold ischemia time, acute rejection episodes, cyclosporine therapy, and waiting time for transplantation, we did not observe early graft function to be a risk factor for graft survival or patient survival. Glomerular filtration rate at 2, 5, and 6 years after kidney transplantation was significantly lower in the poor early graft function than in the control group. Conclusion This study suggested that the quality of early graft function had no significant effect on graft and patient survival rate, but did have a significant influence on long-term renal function.

Early Graft Function After Laparoscopically Procured Living Donor Kidney Transplantation

We determined predictors of poor early graft function after laparoscopic living donor kidney transplantation. We performed an institutional review board approved review of the living donor kidney transplantation database at our institution. Seven of the 510 transplants (1%) were excluded from study due to immediate graft nephrectomy for vascular complications. Of the remaining 503 transplants 48 (9.5%) and 18 (3.6%) had slow and delayed graft function, respectively. Recipient male gender (OR 2.03, 95% CI 1.05-3.91, p = 0.035), black ethnicity (OR 1.59, 95% CI 1.08-2.34, p = 0.020) and donor age (OR 1.03, 95% CI 1.00-1.05, p = 0.021) emerged as independent predictors of poor early graft function in multivariate logistic regression models. Poor early graft function strongly redisposed patients to acute rejection during year 1 (HR 3.43, 95% CI 2.04-5.77, p <0.0001) while grafts from genetically related donors conferred a protective effect (HR 0.40, 95% CI 0.24-0.66, p <0.0001). Three-year death censored allograft survival was lower in the delayed and slow graft function groups than in the immediate function group (89% and 87% vs 98%, p = 0.0068 and 0.0002, respectively). Overall 3-year patient survival was lower in the delayed than in the immediate function group (81% vs 94%, p <0.0001). Male black recipients of laparoscopically procured living donor kidney transplants from donors older than 50 years are at higher risk for poor early graft function, which in turn strongly predicts acute rejection during year 1. This is significant since excellent early graft function confers specific recipient and allograft survival advantages, and may assist physicians in better understanding the various recipient, donor and perioperative parameters that influence clinical outcomes.

2168 INITIAL GRAFT FUNCTION AFTER LAPAROSCOPICALLY PROCURED LIVING DONOR KIDNEY TRANSPLANTATION

2168 INITIAL GRAFT FUNCTION AFTER LAPAROSCOPICALLY PROCURED LIVING DONOR KIDNEY TRANSPLANTATION

The Detrimental Effect of Poor Early Graft Function After Laparoscopic Live Donor Nephrectomy on Graft Outcomes

We undertook this study to assess the rate of poor early graft function (EGF) after laparoscopic live donor nephrectomy (lapNx) and to determine whether poor EGF is associated with diminished long-term graft survival. The study population consisted of 946 consecutive lapNx donors/recipient pairs at our center. Poor EGF was defined as receiving hemodialysis on postoperative day (POD) 1 through POD 7 (delayed graft function [DGF]) or serum creatinine >/= 3.0 mg/dL at POD 5 without need for hemodialysis (slow graft function [SGF]). The incidence of poor EGF was 16.3% (DGF 5.8%, SGF 10.5%), and it was stable in chronologic tertiles. Poor EGF was independently associated with worse death-censored graft survival (adjusted hazard ratio (HR) 2.15, 95% confidence interval (CI) 1.34-3.47, p = 0.001), worse overall graft survival (HR 1.62, 95% CI 1.10-2.37, p = 0.014), worse acute rejection-free survival (HR 2.75, 95% CI 1.92-3.94, p < 0.001) and worse 1-year renal function (p = 0.002). Even SGF independently predicted worse renal allograft survival (HR 2.54, 95% CI 1.44-4.44, p = 0.001). Risk factors for poor DGF included advanced donor age, high recipient BMI, sirolimus use and prolonged warm ischemia time. In conclusion, poor EGF following lapNx has a deleterious effect on long-term graft function and survival.

Analysis of Neurological Complications in Children Transplanted Due to Fulminant Liver Failure

Treatment of patients with fulminant liver failure is a challenge of contemporary medicine. Liver transplantation, in this group, is presently the only reasonable alternative, but in many patients the disastrous condition of the patient results in serious life-threatening complications, including neurological sequelae, which may influence the quality of life after transplantation, and in some cases even cause death. From 1990 to 2004, we performed 241 liver transplantations in children, including 20 transplanted due to fulminant liver failure (8.2%). Serious neurological complications followed liver transplantation in five cases (20%), three of which were fatal. The analysis revealed that the duration of pretransplant coma (grade III or IV) strongly correlated with the incidence of neurological complications ( P < .05). Also a suboptimal quality of the donor liver and poor early graft function may contribute to these posttransplant complications.

Lebertransplantation in Graz: Erfahrungen mit einer neuen Reperfusionsmethode

BACKGROUND: Poor initial graft function secondary to reperfusion remains a major problem in liver transplantation. A new technique of reperfusion was introduced in our center and evaluated in a retrospective study covering the last 6 years. METHODS: Seventy-nine liver transplantations were performed by piggyback technique with retrograde reperfusion via the caval vein and antegrade reperfusion via the portal vein. RESULTS: Sixty-eight out of 74 patients (91.9%) were alive and well at day 8 after LTX. On day 1 after liver transplantation, mean aspartate aminotransferase was 526 U/L and on day 8 it was 48 U/L. Except in the 3 patients presenting with hepatic artery thrombosis, primary nonfunction or poor early graft function did not occur. A postreperfusion syndrome was observed in 3.6%. CONCLUSIONS: After retrograde reperfusion, low postoperative liver enzyme values and good initial liver function can be observed. Furthermore, hemodynamic disturbances were uncommon.

Early Graft Function After Living Donor Kidney Transplantation Predicts Rejection But Not Outcomes

Poor early graft function (EGF) after deceased donor kidney transplantation (DDKT) has been intensely studied. Much less is known about poor EGF after living donor kidney transplantation (LDKT). Data were collected on 469 LDKTs performed between 1/1/97 and 12/31/01 to determine risk factors for and outcomes associated with poor EGF, defined as either delayed or slow graft function (DGF or SGF). The incidence of DGF and SGF were 4.7% and 10.7%, respectively. Diabetic etiology (OR 2.22; p = 0.021) and warm ischemia time (WIT) (OR 1.05 per min increment; p = 0.0025) emerged as independently associated with poor EGF. Neither functional graft survival nor 1-year graft function differed among the EGF groups. However, DGF and SGF strongly predisposed to acute rejection (AR), which compromised functional graft survival (p = 0.0007) and 1-year graft function. Therefore, we conclude that diabetic etiology of renal disease and WIT are the dominant risk factors for poor EGF after LDKT. Poor EGF did not directly compromise functional graft survival but strongly predisposed to AR. We suggest that immunosuppression should be intensified in the poor EGF setting to maximize LDKT longevity, as AR does impair functional graft survival.

Association of intraoperative hypotension and pulmonary hypertension with adverse outcomes after orthotopic liver transplantation

Background Various preoperative, surgical, and postoperative markers of impaired outcome after orthotopic liver transplantation have been reported, but the influence of intraoperative hemodynamic aberrations has not been thoroughly investigated. Setting University Hospital. Study design Retrospective cohort analysis. Methods The authors retrospectively reviewed computerized anesthesia records to determine associations between occurrences of abnormally low or high mean pulmonary artery pressure (MPAP), cardiac output, heart rate, systolic arterial pressure, diastolic arterial pressure, and mean arterial pressure (MAP) with negative surgical outcome. Negative surgical outcome was defined as poor early graft function, primary graft nonfunction, or death attributable to hemodynamic causes. Results Of 789 patients, 142 (18.0%) had negative surgical outcome. Controlling for the influence of United Network for Organ Sharing (UNOS) status > 1, long operation time, cold donor organ ischemia time, and donor age, the only hemodynamic parameters that were independently associated with negative surgical outcome were MAP < 40 mmHg at least once during the procedure (odds ratio [OR] 2.39, p = 0.0016) and MPAP > 40 mmHg at least 3 times during the procedure (OR 2.2, p = 0.035). The occurrence of MAP < 40 mmHg was temporally associated with donor graft reperfusion. Hepatic artery thromboses were not associated with hemodynamic aberrations. Conclusions Hemodynamic events are independently associated with adverse outcomes after orthotopic liver transplantation.