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| Risk factors, surgical complications and graft survival in liver transplant recipients with early allograft dysfunction |
| Douglas Bastos-Neves a , b , ∗, Paolo Rogerio de Oliveira Salvalaggio b , Marcio Diasde Almeida b |
a Digestive and Hepatobiliary Surgery, Hospital São Vicente de Paulo, Rio de Janeiro, Brazil
b Liver Transplant Unit, Hospital Israelita Albert Einstein, São Paulo, Brazil
∗ Corresponding author at: Digestive and Hepatobiliary Surgery, Hospital São Vicente de Paulo, Rua Doutor Satamini, 333, Tijuca, Rio de Janeiro, Brazil.
E-mail address: douglas.bastos@einstein.br (D. Bastos-Neves). |
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Abstract Background: Early allograft dysfunction (EAD) is a severe complication after liver transplantation. The associated risk factors and complications have regained recent interest. This study investigated risk factors, survival and complications associated with EAD in a large liver transplant center in Latin America.
Methods: 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.
Results: 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).
Conclusions: 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.
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2019, Vol. 18 
