Early graft dysfunction after liver transplant: Comparison of different diagnostic criteria in a single-center prospective cohort

• Published in: Medicina intensiva Vol. 44; no. 3; pp. 150 - 159
• Main Authors: Barrueco-Francioni, J.E, Seller-Pérez, G, Lozano-Saéz, R, Arias-Verdú, M.D, Quesada-García, G, Herrera-Gutiérrez, M.E
• Format: Journal Article
• Language: English
• Published: Spain Elsevier España, S.L.U 01.04.2020
• Subjects: Biomarkers - analysis; Cohort Studies; Complicaciones postoperatorias; Criterion; Criterios; Critical Care; Disfunción primaria del injerto; Fallo primario; Female; Hospital Mortality; Humans; Incidence; Intensive Care Units; Liver transplantation; Liver Transplantation - adverse effects; Liver Transplantation - methods; Liver Transplantation - mortality; Logistic Models; Male; Middle Aged; Mortalidad; Mortality; Outcome; Postoperative complication; Primary graft dysfunction; Primary Graft Dysfunction - diagnosis; Primary Graft Dysfunction - epidemiology; Primary Graft Dysfunction - mortality; Primary non function; Prospective Studies; Resultado; ROC Curve; Tissue and Organ Procurement - standards; Trasplante hepático; Primary graft dysfunction; Mortality; Complicaciones postoperatorias; Mortalidad; Disfunción primaria del injerto; Fallo primario; Criterios; Resultado; Criterion; Outcome; Trasplante hepático; Postoperative complication; Primary non function; Liver transplantation
• ISSN: 0210-5691; 1578-6749
• DOI: 10.1016/j.medin.2018.09.004

Abstract Objective Comparison of different diagnostic criteria for early liver allograft dysfunction (EAD) and their capability to predict mortality. Design Single-center, prospective, cohort study. Settings ICU in a Regional Hospital with a liver transplant program since 1997. Patients 253 consecutive patients admitted to our ICU immediately after liver transplantation between 2009 and 2015. Variables of interest Differences in the incidence of EAD and its relation with ICU, Hospital and 2-year mortality depending on the definition applied using as comparator the UNOS (United Network for Organ Sharing) primary non-function criterion. Results The incidence of early liver allograft dysfunction according to UNOS was 13.8%, to Makowka 6.3%, to Ardite 10.7%, to Nanashima 20.6%, to Dhillon 30.8% and to MEAF 13.4%. Kappa test did not show a good correlation among these criteria. EAD was related with ICU mortality for all diagnostic criteria except Dhillon but only UNOS, Makowka and MEAF were associated with 2-year mortality. Hospital mortality was poorly predicted by all criteria except for the MEAF score. Conclusion We found a poor agreement between different criteria analyzed for the diagnosis of EAD. In our population, the MEAF score showed the best relationship with short- and long-term mortality.