Donor information based prediction of early allograft dysfunction and outcome in liver transplantation. (24th January 2014)

• Record Type: Journal Article
• Authors: Hoyer, Dieter P.; Paul, Andreas; Gallinat, Anja; Molmenti, Ernesto P.; Reinhardt, Renate; Minor, Thomas; Saner, Fuat H.; Canbay, Ali; Treckmann, Jürgen W.; Sotiropoulos, Georgios C.; Mathé, Zoltan
• Is Part Of: Liver international. Volume 35(2015)Supplement 1
• Page Start: 156
• Page End: 163
• Publication Date: 2014-01-24
• Subjects: Liver -- Periodicals; Liver -- Diseases -- Periodicals; 616.362
• DOI: 10.1111/liv.12443
• Languages: English
• ISSNs: 1478-3223

Abstract

<abstract abstract-type="main" id="liv12443-abs-0001"> <title>Abstract</title> <sec id="liv12443-sec-0001" sec-type="section"> <title>Background & Aims</title> <p>Poor initial graft function was recently newly defined as early allograft dysfunction (EAD) [Olthoff KM, Kulik L, Samstein B, <italic>et al</italic>. Validation of a current definition of early allograft dysfunction in liver transplant recipients and analysis of risk factors. <italic>Liver Transpl</italic> 2010; 16: 943]. Aim of this analysis was to evaluate predictive donor information for development of EAD.</p> </sec> <sec id="liv12443-sec-0002" sec-type="section"> <title>Methods</title> <p>Six hundred and seventy‐eight consecutive adult patients (mean age 51.6 years; 60.3% men) who received a primary liver transplantation (LT) (09/2003–12/2011) were included. Standard donor data were correlated with EAD and outcome by univariable/multivariable logistic regression and Cox proportional hazards to identify prognostic donor factors after adjustment for recipient confounders. Estimates of relevant factors were utilized for construction of a new continuous risk index to develop EAD.</p> </sec> <sec id="liv12443-sec-0003" sec-type="section"> <title>Results</title> <p>38.7% patients developed EAD. 30‐day survival of grafts with and without EAD was 59.8% and 89.7% (<italic>P</italic> < 0.0001). 30‐day survival of patients with and without EAD was 68.5% and 93.1% (<italic>P</italic> < 0.0001) respectively. Donor body mass index (<italic>P</italic> = 0.0112), gGT (<italic>P</italic> = 0.0471), macrosteatosis (<italic>P</italic> = 0.0006) and cold ischaemia time (CIT) (<italic>P</italic> = 0.0031) were predictors of EAD. Internal cross validation showed a high predictive value (<italic>c</italic>‐index = 0.622).</p> </sec> <sec id="liv12443-sec-0004" sec-type="section"> <title>Conclusions</title> <p>Early allograft dysfunction correlates with early results of LT and can be predicted by donor data only. The newly introduced risk index potentially optimizes individual decisions to accept/decline high risk organs. Outcome of these organs might be improved by shortening CIT.</p> </sec> </abstract>