title: A proposal to grade the severity of early allograft dysfunction after liver transplantation.
abstract: OBJECTIVE
  To propose a grading system for early hepatic graft dysfunction.
  
  
  METHODS
  A retrospective study from a single transplant center. Recipients of liver transplants from deceased donors, transplanted under the MELD system were included. Early graft dysfunction was defined by Olthoff criteria. Multiple cut-off points of post-transplant laboratory tests were used to create a grading system for early graft dysfunction. The primary outcome was 6-months grafts survival.
  
  
  RESULTS
  The peak of aminotransferases during the first postoperative week correlated with graft loss. The recipients were divided into mild (aminotransferase peak >2,000IU/mL, but <3,000IU/mL); moderate (aminotransferase peak >3,000IU/mL); and severe (aminotransferase peak >3,000IU/mL + International Normalized Ratio ≥1.6 and/or bilirubin ≥ 10mg/dL in the 7th postoperative day) early allograft dysfunction. Moderate and severe early dysfunctions were independent risk factors for graft loss. Patients with mild early dysfunction presented with graft and patient survival comparable to those without graft dysfunction. However, those with moderate early graft dysfunction showed worse graft survival than those who had no graft dysfunction. Patients with severe early dysfunction had graft and patient survival rates worse than those of any other groups.
  
  
  CONCLUSIONS
  Early graft dysfunction can be graded by a simple and reliable criteria based on the peak of aminotransferases during the first postoperative week. The severity of the early graft dysfunction is an independent risk factor for allograft loss. Patients with moderate early dysfunction showed worsening of graft survival. Recipients with severe dysfunction had a significantly worse prognosis for graft and patient survival.
authors.affiliation: Unidade de Transplante de Fígado, Hospital Israelita Albert Einstein, São Paulo, SP, Brasil.
authors.forename: Paolo
authors.initials: P
authors.lastname: Salvalaggio
authors.forename: Rogerio Carballo
authors.initials: RC
authors.lastname: Afonso
authors.forename: Guilherme
authors.initials: G
authors.lastname: Felga
authors.forename: Ben-Hur
authors.initials: BH
authors.lastname: Ferraz-Neto
mesh_terms: D000293:Adolescent; D000328:Adult; D001663:Bilirubin / Q000097:blood; D015415:Biomarkers / Q000097:blood; D004812:Epidemiologic Methods; D005260:Female; D006085:Graft Survival / Q000502:physiology; D006801:Humans; D017093:Liver Failure / Q000503:physiopathology / Q000601:surgery*; D016031:Liver Transplantation / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D055031:Primary Graft Dysfunction / Q000145:classification*; D012720:Severity of Illness Index; D013997:Time Factors; D014019:Tissue Donors; D000637:Transaminases / Q000097:blood; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D015415:Biomarkers; D000637:Transaminases; D001663:Bilirubin