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Elevated alanine aminotransferase ( ALT ) in the deceased donor: impact on early post‐transplant liver allograft function
Author(s) -
Mangus Richard S,
Fridell Jonathan A,
Kubal Chandrashekhar A,
Davis Jason P,
Joseph Tector A.
Publication year - 2015
Publication title -
liver international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.873
H-Index - 110
eISSN - 1478-3231
pISSN - 1478-3223
DOI - 10.1111/liv.12508
Subject(s) - medicine , alanine aminotransferase , gastroenterology , liver transplantation , liver function , liver injury , proportional hazards model , surgery , alanine transaminase , transplantation
Background & Aims Serum alanine aminotransferase ( ALT ) levels are frequently elevated with liver injury and such elevations are common in deceased organ donors. The impact of this injury on early liver allograft function has not been well described. This study analyses the immediate function and 1‐year graft and patient survival for liver allografts stratified by peak serum ALT levels in the deceased donor. Methods The on‐site organ procurement records for 1348 consecutive deceased liver donors were reviewed (2001–2011). Serum ALT was categorized into three study groups: normal/mild elevation, 0–499 μ/L; moderate elevation, 500–999 μ/L (>10× upper limit of normal) and severe elevation, ≥1000 μ/L (>20× upper limit of normal). Outcomes included early graft function and graft loss, and 1‐year graft and patient survival. Results Distribution of subjects included: normal/mild, 1259 (93%); moderate, 34 (3%) and severe, 55 (4%). Risk of 30‐day graft loss for the three study groups was: 72 (6%), 3 (9%) and 3 (6%) ( P = 0.74). Graft and patient survival at 1 year for the three groups was: normal/mild, 1031 (87%), 1048 (88%); moderate, 31 (91%), 31 (91%) and severe, 43 (88%), 44 (90%) ( P = 0.71, 0.79). Cox proportional hazards modelling of survival while controlling for donor age and recipient model for end‐stage liver disease score ( MELD ) demonstrates no statistically significant difference among the three study groups. Conclusions This study demonstrates clinical equivalence in early graft function and 1‐year graft and patient survival for donor livers with varying peak levels of serum ALT . These donor allografts may, therefore, be utilized successfully.