Evaluation of the updated definition of early allograft dysfunction in donation after brain death and donation after cardiac death liver allografts.
BACKGROUND
An updated definition of early allograft dysfunction (EAD) was recently validated in a multicenter study of 300 deceased donor liver transplant recipients. This analysis did not differentiate between donation after brain death (DBD) and donation after cardiac death (DCD) allograft recipients.


METHODS
We reviewed our prospectively entered database for all DBD (n=377) and DCD (n=38) liver transplantations between January 1, 2006 and October 30, 2011. The incidence of EAD as well as its ability to predict graft failure and survival was compared between DBD and DCD groups.


RESULTS
EAD was a valid predictor of both graft and patient survival at six months in DBD allograft recipients, but in DCD allograft recipients there was no significant difference in the rate of graft failure in those with EAD (11.5%) compared with those without EAD (16.7%) (P=0.664) or in the rate of death in recipients with EAD (3.8%) compared with those without EAD (8.3%) (P=0.565). The graft failure rate in the first 6 months in those with international normalized ratio ≥1.6 on day 7 who received a DCD allograft was 37.5% compared with 6.7% for those with international normalized ratio <1.6 on day 7 (P=0.022).


CONCLUSIONS
The recently validated definition of EAD is a valid predictor of patient and graft survival in recipients of DBD allografts. On initial assessment, it does not appear to be a useful predictor of patient and graft survival in recipients of DCD allografts, however a study with a larger sample size of DCD allografts is needed to confirm these findings. The high ALT/AST levels in most recipients of DCD livers as well as the predisposition to biliary complications and early cholestasis make these parameters as poor predictors of graft failure. An alternative definition of EAD that gives greater weight to the INR on day 7 may be more relevant in this population.
Multi-Organ Transplant Program, London Health Sciences Centre, The University of Western Ontario, London, Canada. kris.croome@hotmail.com
Kris P
KP
Croome
William
W
Wall
Douglas
D
Quan
Sai
S
Vangala
Vivian
V
McAlister
Paul
P
Marotta
Roberto
R
Hernandez-Alejandro
D000328:Adult; D001660:Biliary Tract Diseases / Q000209:etiology; D001926:Brain Death; D002779:Cholestasis / Q000209:etiology; D005260:Female; D006085:Graft Survival; D006801:Humans; D015994:Incidence; D019934:International Normalized Ratio; D016031:Liver Transplantation / Q000009:adverse effects* / Q000401:mortality; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009864:Ontario; D011237:Predictive Value of Tests; D055031:Primary Graft Dysfunction / Q000145:classification / Q000175:diagnosis / Q000209:etiology* / Q000401:mortality; D018570:Risk Assessment; D012307:Risk Factors; D009626:Terminology as Topic; D013997:Time Factors; D014019:Tissue Donors; D016896:Treatment Outcome