title: Donor information based prediction of early allograft dysfunction and outcome in liver transplantation.
abstract: OBJECTIVE
  Poor initial graft function was recently newly defined as early allograft dysfunction (EAD) [Olthoff KM, Kulik L, Samstein B, et al. Validation of a current definition of early allograft dysfunction in liver transplant recipients and analysis of risk factors. Liver Transpl 2010; 16: 943]. Aim of this analysis was to evaluate predictive donor information for development of EAD.
  
  
  METHODS
  Six hundred and seventy-eight consecutive adult patients (mean age 51.6 years; 60.3% men) who received a primary liver transplantation (LT) (09/2003-12/2011) were included. Standard donor data were correlated with EAD and outcome by univariable/multivariable logistic regression and Cox proportional hazards to identify prognostic donor factors after adjustment for recipient confounders. Estimates of relevant factors were utilized for construction of a new continuous risk index to develop EAD.
  
  
  RESULTS
  38.7% patients developed EAD. 30-day survival of grafts with and without EAD was 59.8% and 89.7% (P < 0.0001). 30-day survival of patients with and without EAD was 68.5% and 93.1% (P < 0.0001) respectively. Donor body mass index (P = 0.0112), gGT (P = 0.0471), macrosteatosis (P = 0.0006) and cold ischaemia time (CIT) (P = 0.0031) were predictors of EAD. Internal cross validation showed a high predictive value (c-index = 0.622).
  
  
  CONCLUSIONS
  Early allograft dysfunction correlates with early results of LT and can be predicted by donor data only. The newly introduced risk index potentially optimizes individual decisions to accept/decline high risk organs. Outcome of these organs might be improved by shortening CIT.
authors.affiliation: Department of General, Visceral and Transplantation Surgery, University Hospital, Essen, Germany.
authors.forename: Dieter P
authors.initials: DP
authors.lastname: Hoyer
authors.forename: Andreas
authors.initials: A
authors.lastname: Paul
authors.forename: Anja
authors.initials: A
authors.lastname: Gallinat
authors.forename: Ernesto P
authors.initials: EP
authors.lastname: Molmenti
authors.forename: Renate
authors.initials: R
authors.lastname: Reinhardt
authors.forename: Thomas
authors.initials: T
authors.lastname: Minor
authors.forename: Fuat H
authors.initials: FH
authors.lastname: Saner
authors.forename: Ali
authors.initials: A
authors.lastname: Canbay
authors.forename: Jürgen W
authors.initials: JW
authors.lastname: Treckmann
authors.forename: Georgios C
authors.initials: GC
authors.lastname: Sotiropoulos
authors.forename: Zoltan
authors.initials: Z
authors.lastname: Mathé
mesh_terms: D000328:Adult; D000367:Age Factors; D064591:Allografts / Q000503:physiopathology*; D001663:Bilirubin / Q000097:blood; D015992:Body Mass Index; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D016031:Liver Transplantation / Q000009:adverse effects* / Q000706:statistics & numerical data; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D063305:Organ Dysfunction Scores; D011237:Predictive Value of Tests; D012307:Risk Factors; D012737:Sex Factors; D014019:Tissue Donors / Q000706:statistics & numerical data*
chemical_list: D001663:Bilirubin
keywords: donor risk factors; early allograft dysfunction; liver transplantation; multivariable analysis; scoring system