Patterns of Early Allograft Dysfunction in Adult Live Donor Liver Transplantation: The A2ALL Experience. Issue 7 (July 2016)

• Record Type: Journal Article
• Authors: Pomposelli, James J.; Goodrich, Nathan P.; Emond, Jean C.; Humar, Abhinav; Baker, Talia B.; Grant, David R.; Fisher, Robert A.; Roberts, John P.; Olthoff, Kim M.; Gillespie, Brenda W.; Merion, Robert M.
• Is Part Of: Transplantation. Volume 100:Issue 7(2016)
• Publication Date: 2016-07
• Subjects: Transplantation of organs, tissues, etc -- Periodicals; Transplantation immunology -- Periodicals; 617.95
• DOI: 10.1097/TP.0000000000001240
• Languages: English
• ISSNs: 0041-1337

Abstract

Abstract : Background: Early allograft dysfunction (EAD) after living donor liver transplantation (LDLT) has often been attributed to inadequate graft size, and termed small-for-size syndrome. Early allograft dysfunction definitions include a variable constellation of findings, including hyperbilirubinemia, coagulopathy, encephalopathy, and ascites formation. Among putative causes of EAD after LDLT are excessive portal pressure and/or flow. Our objective was to evaluate patterns of EAD after LDLT. Methods: In this study, 631 LDLT recipients were monitored for complications, EAD (defined by postoperative day 7 bilirubin >10 mg/dL or international normalized ratio >1.6), and graft failure. Approximately 200 had portal venous and arterial pressure and flow measurements before and after LDLT. Portal inflow modification (splenic artery ligation, hemiportocaval shunt, or splenectomy) was performed at the discretion of the operating surgeon. Associations between EAD and recipient, donor, and transplant factors were examined using multivariable logistic regression. Results: Risk of EAD was associated with left lobe grafts, lower graft weight among left lobes, higher preoperative bilirubin, higher portal reperfusion pressure, higher donor age, and higher donor body mass index. The risk of graft loss within the first 90 days was 5.2 times higher for recipients with EAD versus those without EAD ( P < 0.001). Conclusions: Early allograft dysfunction can be defined using postoperative day 7 laboratory values that are highly predictive of early graft failure within 90 days. Risk factors associated with EAD after LDLT include: graft type and size, preoperative bilirubin, portal reperfusion pressure, donor age, and donor body mass index. Abstract : The authors of this study based on the Adult-to-Adult Living Donor Liver Transplantation (LDLT) Cohort Study demonstrate that early allograft dysfunction following LDLT, defined using postoperative day-7 labs, is associated with left lobe grafts, lower graft weight among left lobes, higher preoperative bilirubin and portal reperfusion pressure, older donor age, and higher donor BMI. Supplemental digital content is available in the text.