Preoperative donor scores and postoperative early measures of graft function: relevance to the outcome of liver transplantation.
BACKGROUND
Several donor and recipient parameters play a role in the determination of post-liver transplant allograft function. The identification of prognostic indices presents great implications for correct allocation of donors and more targeted recipient management. The aim of our review was to detect the role of preoperative scoring systems and early postoperative measures of graft function as predictive factors for the development of graft failure and recipient death.


METHODS
We stratified a cohort of 97 patients in two groups according to a 1-year functional (Group A; n = 72) versus non-functional (Group B; n = 25) status of the allograft.


RESULTS
Patients in group B showed higher preoperative Model for End-stage Liver Disease (MELD) values, longer warm ischemia times, reduced bile outputs and increased peak values of transaminases and INR content within the first 3 days after transplantation. Group B showed 48% of patients with initial poor graft function. The parameters which resulted in a significant prediction of graft loss by multivariate analysis were MELD (P = .012); postoperative day 1 serum alanine aminotransferase (ALT) (P < .0001) and day 3 ALT (P = .003). The predictive factors for patient death were postoperative day 1 serum ALT (P < .0001) and day 3 ALT (P = .001).


CONCLUSIONS
MELD score was a useful preoperative parameter for the prediction of post-transplant graft survival. Early ALT values predicted both graft and recipient survivals. Minimization of parameters related to their peaks (warm ischemia time) may improve graft and patients survival rates.
Department of General Surgery and Organ Transplantation, La Sapienza Università di Roma, Umberto I Policlinico di Roma, Rome, Italy. lai.quirino@libero.it
Q
Q
Lai
A
A
Molinaro
G
G
Mennini
F
F
Nudo
V
V
Morabito
S Ginanni
SG
Corradini
G
G
Novelli
P B
PB
Berloco
M
M
Rossi
D000328:Adult; D000368:Aged; D000437:Alcoholism / Q000150:complications / Q000601:surgery; D015992:Body Mass Index; D015331:Cohort Studies; D016001:Confidence Intervals; D005260:Female; D005500:Follow-Up Studies; D006509:Hepatitis B / Q000150:complications / Q000601:surgery; D006526:Hepatitis C / Q000150:complications / Q000601:surgery; D006801:Humans; D016031:Liver Transplantation / Q000502:physiology*; D008297:Male; D008875:Middle Aged; D011184:Postoperative Period; D057234:Preoperative Period; D016016:Proportional Hazards Models; D012044:Regression Analysis; D013997:Time Factors; D014184:Transplantation, Homologous; D016896:Treatment Outcome