Patterns of Early Allograft Dysfunction in Adult Live Donor Liver Transplantation
Year: 2016
Type: article
Study design: Observational Study
Abstract: In Brief 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. 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.
Source: Transplantation
Institutions: Lahey Hospital and Medical Center, University Health Network, University of California, San Francisco, University of Toronto, Toronto General Hospital, Lahey Medical Center, University of Pittsburgh Medical Center, Arbor Research Collaborative for Health, Columbia University, University of Pennsylvania
Language: English
Subfield: Surgery
Field: Medicine
Domain: Health Sciences
Open Access status: green
Awards: Adult-to-Adult Living Donor Liver Transplantation Study Data Coordinating Center, G1186205276, G1433264716, Living Donor Liver Transplant :Short & Long-Term Impact on Donors and Recipients, G2846024233, G3732980780, Adult to Adult Living Donor Liver Transplantation Cohort Study, A2ALL Cohort Study: Pyschosocial and Surgical Outcomes, Adult to Adult Living Donor Liver Transplantation, G6485789737, G6533405083, G8384303206, G8885385322
OpenAlex ID: W2466242530