Early graft dysfunction following adult-to-adult living-related liver transplantation: predictive factors and outcomes.
OBJECTIVE
To describe a condition that we define as early graft dysfunction (EGD) which can be identified preoperatively.


METHODS
Small-for-size graft dysfunction following living-related liver transplantation (LRLT) is characterized by EGD when the graft-to-recipient body weight ratio (GRBWR) is below 0.8%. However, patients transplanted with GRBWR above 0.8% can develop dysfunction of the graft. In 73 recipients of LRLT (GRBWR > 0.8%), we identified 10 patients who developed EGD. The main measures of outcomes analyzed were overall mortality, number of re-transplants and length of stay in days (LOS). Furthermore we analyzed other clinical pre-transplant variables, intra-operative parameters and post transplant data.


RESULTS
A trend in favor of the non-EGD group (3-mo actuarial survival 98% vs 88%, P = 0.09; 3-mo graft mortality 4.7% vs 20%, P = 0.07) was observed as well as shorter LOS (13 d vs 41.5 d; P = 0.001) and smaller requirement of peri-operative Units of Plasma (4 vs 14; P = 0.036). Univariate analysis of pre-transplant variables identified platelet count, serum bilirubin, INR and Meld-Na score as predictors of EGD. In the multivariate analysis transplant Meld-Na score (P = 0.025, OR: 1.175) and pre-transplant platelet count (P = 0.043, OR: 0.956) were independently associated with EGD.


CONCLUSIONS
EGD can be identified preoperatively and is associated with increased morbidity after LRLT. A prompt recognition of EGD can trigger a timely treatment.
Department of Surgery, University of Pittsburgh, Coordinator Abdominal Adult Transplant. ISMETT Mediterranean Institute for Transplant and Advanced Specialized Therapies, University of Pittsburgh Medical Center in Italy, 90127 Palermo, Italy. sgruttadauria@ismett.edu
Salvatore
S
Gruttadauria
Fabrizio
F
di Francesco
Giovanni-Battista
GB
Vizzini
Angelo
A
Luca
Marco
M
Spada
Davide
D
Cintorino
Sergio
S
Li Petri
Giada
G
Pietrosi
Duilio
D
Pagano
Bruno
B
Gridelli
D000293:Adolescent; D000328:Adult; D005190:Family; D005260:Female; D006801:Humans; D016031:Liver Transplantation; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D055031:Primary Graft Dysfunction / Q000175:diagnosis* / Q000401:mortality; D016896:Treatment Outcome; D055815:Young Adult