Von Willebrand factor to protein C ratio-related thrombogenicity with systemic inflammation is predictive of graft dysfunction after liver transplantation: Retrospective cohort study. (December 2020)

• Record Type: Journal Article
• Authors: Kwon, Hye-Mee; Kim, Kyoung-Sun; Park, Jihoon; Jeong, Junhyeop; Moon, Young-Jin; Song, Jun-Gol; Hwang, Gyu-Sam; Kim, Ki-Hun; Jun, In-Gu
• Is Part Of: International journal of surgery. Volume 84(2020)
• Page Start: 109
• Page End: 116
• Publication Date: 2020-12
• Subjects: Living-donor liver transplantation -- Early allograft dysfunction -- Thrombogenicity -- von willebrand factor -- Protein C -- Systemic inflammation; Surgery -- Periodicals; Surgical Procedures, Operative -- Periodicals; 617.005
• DOI: 10.1016/j.ijsu.2020.10.030
• Languages: English
• ISSNs: 1743-9191

Abstract

Abstract: Introduction: Early allograft dysfunction (EAD) is known to be a prototype of graft failure and ultimately influences long-term graft failure or death. We hypothesized that pretransplant thrombogenicity evaluated by procoagulant and anticoagulant, von Willebrand factor (vWF), factor Ⅷ (FⅧ), protein C (PC) and their imbalance ratio of vWF-to-PC (vWFPCR) and FVIII-to-PC (FⅧPCR), is associated with EAD and 90-day graft failure after living-related liver transplantation (LDLT) and contributes to further exacerbation of graft dysfunction when coexists with systemic inflammation. Material and methods: Of 1199 prospectively registered LDLT patients, 698 with measurements of each thrombogenicity parameters were analyzed. Risk factors for EAD development were searched and subsequent best cut-offs was calculated according to the receiver operator characteristic curve analysis. When comparing the outcome, multivariable regression analysis and inverse probability of treatment weighting (IPTW) of the propensity score were performed. Results: The prevalence of EAD was 10.7% (n = 75/698) after LDLT. Of parameters, vWFPCR had highest predictivity potential of EAD with the best cut-off of 8.06. The relationship between vWFPCR≥8.06 showed significant association with EAD development (OR [95%CI], 2.55[1.28–5.09], P = 0.008) and 90-day graft failure (HR [95%CI], 2.24 [1–4.98], P = 0.043) after IPTW-adjustment. Furthermore, risk of EAD increased proportionally with increasing C-reactive protein as a continuous metric of systemic inflammation, and more steeply in those with higher thrombogenicity (i.e., higher vWFPCR). Adding vWFPCR to MELD score improved EAD risk prediction by 21.9%. Conclusions: Pretransplant thrombogenicity assessed by imbalance of pro- and anticoagulant, was significantly associated with EAD and 90-day graft failure after LDLT and this association was worsened by systemic inflammation. Highlights: Early allograft dysfunction (EAD) is an early indicator of transplanted graft function after liver transplant and dramatically influences graft failure or mortality. Pretransplant thrombogenicity assessed by von Willebrand factor -to-protein C ratio, a parameter showing the imbalance of pro- and anticoagulant, could significantly prognosticate EAD after LDLT. This association was further worsened by systemic inflammation. Adding vWFPCR to MELD score improved EAD risk prediction by 21.9%.