title: Early detection of the graft failure after pediatric liver transplantation: a Bergamo experience.
abstract: BACKGROUND
  Effective indicators of the early graft failure after pediatric liver transplantation are currently a crucial question. The aim of this study was to analyze retrospectively laboratory parameters that may help anticipate an early graft loss (GL).
  
  
  METHODS
  The 131 pediatric liver transplantations, performed in our hospital from January 2002 to December 2005, were reviewed. Post-operative laboratory parameters, collected in the first 36 h of the Paediatric Intensive Care Unit (PICU) stay, were analyzed for children with both graft survival and GL. Receiver operating characteristics analysis was used to identify the optimal cut-off for the laboratory parameters. Multivariate logistic regression analysis was used to calculate the adjusted risk of GL for the prognostic parameters identified.
  
  
  RESULTS
  The mean age at transplant was 1.1 years. The two groups were comparable for all recipient and donor variables considered. Children with GL showed significantly higher levels of ammonia and transaminase at the admission to the PICU and higher levels of prothrombin time, creatinine, lactate and a lower level of platelets at the 36 h of PICU. The laboratory parameters over the cut-off value by the multivariate logistic regression identified all early thromboses earlier than Doppler ultrasound.
  
  
  CONCLUSIONS
  This study suggests that routine blood tests may help to anticipate an early loss of liver grafts in children after transplantation and may improve our diagnostic investigation in the case of thrombosis suspicion. Further validation by a prospective study is needed to carefully assess the sensitivity and specificity of the identified criteria.
authors.affiliation: Department of Anesthesia and Intensive Care, Paediatric Intensive Care Unit, Riuniti Hospital, Bergamo, Italy. mirco.nacoti@tiscali.it
authors.forename: Mirco
authors.initials: M
authors.lastname: Nacoti
authors.forename: S
authors.initials: S
authors.lastname: Barlera
authors.forename: D
authors.initials: D
authors.lastname: Codazzi
authors.forename: E
authors.initials: E
authors.lastname: Bonanomi
authors.forename: M
authors.initials: M
authors.lastname: Passoni
authors.forename: S
authors.initials: S
authors.lastname: Vedovati
authors.forename: L
authors.initials: L
authors.lastname: Rota Sperti
authors.forename: M
authors.initials: M
authors.lastname: Colledan
authors.forename: R
authors.initials: R
authors.lastname: Fumagalli
mesh_terms: D001772:Blood Cell Count; D001774:Blood Chemical Analysis; D001784:Blood Gas Analysis; D002675:Child, Preschool; D042241:Early Diagnosis; D023381:Endpoint Determination; D005260:Female; D006085:Graft Survival / Q000502:physiology*; D006801:Humans; D007223:Infant; D008111:Liver Function Tests; D016031:Liver Transplantation / Q000502:physiology*; D016015:Logistic Models; D008297:Male; D010976:Platelet Count; D012372:ROC Curve; D013927:Thrombosis / Q000175:diagnosis / Q000209:etiology; D017211:Treatment Failure; D018608:Ultrasonography, Doppler