Risk factors, surgical complications and graft survival in liver transplant recipients with early allograft dysfunction

• Published in: Hepatobiliary & pancreatic diseases international Vol. 18; no. 5; pp. 423 - 429
• Main Authors: Bastos-Neves, Douglas, Salvalaggio, Paolo Rogerio de Oliveira, Almeida, Marcio Dias de
• Format: Journal Article
• Language: English
• Published: Singapore Elsevier B.V 01.10.2019; Digestive and Hepatobiliary Surgery, Hospital S?o Vicente de Paulo, Rio de Janeiro, Brazil; Liver Transplant Unit, Hospital Israelita Albert Einstein, S?o Paulo, Brazil%Liver Transplant Unit, Hospital Israelita Albert Einstein, S?o Paulo, Brazil
• Subjects: Adult; Age Factors; Allografts - physiopathology; Cold Ischemia - adverse effects; Delayed Graft Function - etiology; Donor evaluation; Female; Graft Survival; Humans; Hypernatremia - complications; Liver transplantation; Liver Transplantation - adverse effects; Male; Middle Aged; Obesity - complications; Postoperative Complications - etiology; Primary graft dysfunction; Protective Factors; Reperfusion Injury - complications; Retrospective Studies; Risk Factors; Sex Factors; Warm Ischemia - adverse effects; Young Adult; Graft survival; Donor evaluation; Primary graft dysfunction; Liver transplantation
• ISSN: 1499-3872
• DOI: 10.1016/j.hbpd.2019.02.005

Early allograft dysfunction (EAD) is a severe complication after liver transplantation. The associated risk factors and complications have re-gained recent interest. This study investigated risk factors, survival and complications associated with EAD in a large liver transplant center in Latin America. Retrospective, unicenter, cohort, based on data from adult patients undergoing first deceased-donor liver transplant from January 2009 to December 2013. EAD was defined by one or more of the following: (i) bilirubin ≥10 mg/dL on postoperative day 7; (ii) international normalized ratio ≥1.6 on postoperative day 7, and (iii) alanine aminotransferase or aspartate aminotransferase >2000 IU/L within the first seven days after transplant. A total of 602 patients were included; of these 34.2% developed EAD. Donor risk factors were male (P = 0.007), age between 50 and 59 years (P = 0.034), overweight (P = 0.028) or grade I obesity (P = 0.012), sodium >157 mmol/L (P = 0.002) and grade IV ischemia/reperfusion injury (P = 0.002). Cold ischemia time ≥10 h (P = 0.008) and warm ischemia time ≥40 min (P = 0.013) were the surgical factors. Male (P <0.001) was the only recipient protective factor. Compared with the non-EAD group, patients with EAD were submitted to more reoperations (24.3% vs. 13.4%, P = 0.001) and had higher graft loss rates (37.9% vs. 21.2%, P <0.001), with similar patient survival rates (P = 0.238). EAD risk factors are related to donor, surgical procedure and recipient. Donor risk factors for EAD were male, age between 50 and 59 years, donor overweight or grade I obesity, sodium >157 mmol/L and grade IV ischemia/reperfusion injury. Cold ischemia time ≥10 h and warm ischemia time ≥40 min were the surgical risk factors. Male was the only recipient protective factor. Patients with EAD had higher reoperations and graft loss rates.