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.
Gruttadauria
Salvatore
S
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
di Francesco
Fabrizio
F
Vizzini
Giovanni-Battista
GB
Luca
Angelo
A
Spada
Marco
M
Cintorino
Davide
D
Li Petri
Sergio
S
Pietrosi
Giada
G
Pagano
Duilio
D
Gridelli
Bruno
B
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