title: Risk factors and criteria predicting early graft loss after adult-to-adult living donor liver transplantation.
abstract: BACKGROUND
  Because deceased liver donors are scarce, adult-to-adult living donor liver transplantation (LDLT) is considered a suitable alterative. However, LDLT grafts are usually partial, resulting in a higher risk of early graft loss (EGL). The aim of the present study was to identify the risk factors and criteria predicting EGL after LDLT.
  
  
  METHODS
  We retrospectively analyzed 178 consecutive adults who underwent LDLT. The recipients were divided into two groups as follows: group I, wherein patients showed graft survival longer than 3 mo after LDLT (n = 164), and group II, wherein graft loss occurred within 3 mo after transplantation (n = 14).
  
  
  RESULTS
  Univariate analysis showed various risk factors; however, only the preoperative model for end-stage liver disease score, the presence of obvious pretransplant portal hypertension, and intraoperative blood loss were identified as independent predictors of EGL by multivariate analysis. After LDLT, significant differences were observed between the groups in the fold change in total bilirubin levels over postoperative day (POD) 1 (TBIL-f1) and in the international normalized ratio over POD 1 (INR-f1). The combination of TBIL-f1 and INR-f1 on POD 10 was found to be a strong EGL predictor. Furthermore, a minimum indocyanine green (ICG) clearance rate constant K (m-KICG) <0.100/min after POD 3 was found to be the strongest predictor of EGL (sensitivity, 100%; specificity, 97.2%).
  
  
  CONCLUSIONS
  The postoperative m-KICG and combination of TBIL-f1 and INR-f1 on POD 10 were useful predictors of EGL; moreover, m-KICG was superior and is expected to be especially useful for ensuring timely retransplantation.
authors.affiliation: Department of Liver Surgery, Liver Transplantation Center, West China Hospital, Sichuan University, Chengdu, China.
authors.forename: ZhengGui
authors.initials: Z
authors.lastname: Du
authors.affiliation: Department of Liver Surgery, Liver Transplantation Center, West China Hospital, Sichuan University, Chengdu, China.
authors.forename: YongGang
authors.initials: Y
authors.lastname: Wei
authors.affiliation: Department of Liver Surgery, Liver Transplantation Center, West China Hospital, Sichuan University, Chengdu, China.
authors.forename: KeFei
authors.initials: K
authors.lastname: Chen
authors.affiliation: Department of Liver Surgery, Liver Transplantation Center, West China Hospital, Sichuan University, Chengdu, China.
authors.forename: Xi
authors.initials: X
authors.lastname: Chen
authors.affiliation: Department of Liver Surgery, Liver Transplantation Center, West China Hospital, Sichuan University, Chengdu, China.
authors.forename: ZhiJun
authors.initials: Z
authors.lastname: Zhang
authors.affiliation: Department of Liver Surgery, Liver Transplantation Center, West China Hospital, Sichuan University, Chengdu, China.
authors.forename: HongYu
authors.initials: H
authors.lastname: Li
authors.affiliation: Department of Liver Surgery, Liver Transplantation Center, West China Hospital, Sichuan University, Chengdu, China.
authors.forename: Yu
authors.initials: Y
authors.lastname: Ma
authors.affiliation: Department of Liver Surgery, Liver Transplantation Center, West China Hospital, Sichuan University, Chengdu, China. Electronic address: doclibo@gmail.com.
authors.forename: Bo
authors.initials: B
authors.lastname: Li
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D056808:Biostatistics; D004396:Coloring Agents; D058625:End Stage Liver Disease / Q000453:epidemiology* / Q000601:surgery; D005260:Female; D006085:Graft Survival; D006801:Humans; D006975:Hypertension, Portal / Q000453:epidemiology; D007208:Indocyanine Green; D016031:Liver Transplantation / Q000009:adverse effects* / Q000706:statistics & numerical data; D019520:Living Donors / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D009929:Organ Size; D011237:Predictive Value of Tests; D055031:Primary Graft Dysfunction / Q000175:diagnosis* / Q000453:epidemiology*; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D012680:Sensitivity and Specificity; D055815:Young Adult
chemical_list: D004396:Coloring Agents; D007208:Indocyanine Green
keywords: Early graft loss; Graft dysfunction; Indocyanine green test; Living donor liver transplantation; Small for size