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Predictive model and risk factors associated with a revised definition of early allograft dysfunction in liver transplant recipients
Author(s) -
NicolauRaducu Ramona,
Cohen Ari J.,
Bokhari Amjad,
Bohorquez Humberto,
Bruce David,
Carmody Ian,
Bugeaud Emily,
Seal John,
Sonnier Dennis,
Nossaman Bobby,
Loss George
Publication year - 2017
Publication title -
clinical transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.918
H-Index - 76
eISSN - 1399-0012
pISSN - 0902-0063
DOI - 10.1111/ctr.13097
Subject(s) - medicine , incidence (geometry) , logistic regression , dialysis , liver transplantation , hepatocellular carcinoma , gastroenterology , surgery , renal function , transplantation , physics , optics
Early allograft dysfunction ( EAD ) is a well‐defined clinical syndrome that reflects overall graft function within the first week after transplant. The aim of this study was to further refine the definition for EAD . Method In this study, 1124 patients were included for analysis. Logistic regression was performed to identify markers of liver injury associated with 6‐month patient and graft failure. Results Recursive partitioning identified cut‐points for ALT / AST > 3000/6000 IU / dL observed within first week, with bilirubin ≥ 10 mg/ dL and INR ≥ 1.6 on postoperative day 7 for the revised EAD model. The incidence of updated EAD was 15% (164/1124). Multivariable analysis identified eight risk factors associated with EAD : % macrosteatosis, donor location, donor weight, nonheart beating donors, type of organ transplanted, recipient‐associated hepatocellular carcinoma, severity of postreperfusion syndrome, and the amount of transfused fresh frozen plasma. In the presence of EAD , the incidence of post‐transplant renal replacement therapy and dialysis dependence increases. There was a significant association of the presence of EAD with 6‐month mortality (12% vs 3%) and 6‐month graft failure (8% vs 1%). Conclusion Higher AST / ALT level needed as cutoff in comparison with the old EAD definition.