title: Early allograft dysfunction after liver transplantation: an intermediate outcome measure for targeted improvements.
abstract: BACKGROUND
  The term early allograft dysfunction (EAD) identifies liver transplant (LT) allografts with initial poor function and portends poor allograft and patient survival. Aims of this study are to use EAD as an intermediate outcome measure in a large single center cohort and identify donor, recipient and peri-operative risk factors.
  
  
  METHODS
  In 1950 consecutive primary LT, donor, recipient and peri-operative data were collected. EAD was defined by the presence of one or more of the following: total bilirubin ≥ 10 mg/dL (171 μmol/L) or, INR ≥ 1.6 on day 7, and ALT/AST > 2,000 IU/L within the first 7 days.
  
  
  RESULTS
  The incidence of EAD was 26.5%. 1-, 3-, and 5-year allograft and patient survival for patients who developed EAD were significantly inferior to those who did not (P < 0.01 at all time points). Multivariate analysis demonstrated associations in the development of EAD with recipient pre-operative ventilator status, donation after cardiac death allografts, donor age, allograft size, degree of steatosis, operative time and intra-operative transfusion requirements (all P < 0.01). Patients with EAD had a significantly longer hospitalization at 20.9 ± 38.9 days (median: 9; range: 4-446) compared with 10.7 ± 13.5 days (median: 7; range: 3-231) in patients with no EAD (P < 0.01).
  
  
  CONCLUSIONS
  This is the largest single center experience demonstrating incidence of EAD and identifying factors associated with development of EAD. EAD is a useful intermediate outcome measure for allograft and patient survival. Balancing recipient pretransplant conditions, donor risk factors and intra-operative conditions are necessary for avoiding EAD.
authors.affiliation: Mayo Clinic Collaborative in Transplant Research and Outcomes, Department of Transplant. Mayo Clinic Florida. USA.
authors.forename: David D
authors.initials: DD
authors.lastname: Lee
authors.affiliation: Mayo Clinic Collaborative in Transplant Research and Outcomes, Department of Transplant. Mayo Clinic Florida. USA.
authors.forename: Kristopher P
authors.initials: KP
authors.lastname: Croome
authors.affiliation: Mayo Clinic Collaborative in Transplant Research and Outcomes, Department of Transplant. Mayo Clinic Florida. USA.
authors.forename: Jefree A
authors.initials: JA
authors.lastname: Shalev
authors.affiliation: Mayo Clinic Collaborative in Transplant Research and Outcomes, Department of Transplant. Mayo Clinic Florida. USA.
authors.forename: Kaitlyn R
authors.initials: KR
authors.lastname: Musto
authors.affiliation: Mayo Clinic Collaborative in Transplant Research and Outcomes, Department of Transplant. Mayo Clinic Florida. USA.
authors.forename: Meenu
authors.initials: M
authors.lastname: Sharma
authors.affiliation: Mayo Clinic Collaborative in Transplant Research and Outcomes, Department of Transplant. Mayo Clinic Florida. USA.
authors.forename: Andrew P
authors.initials: AP
authors.lastname: Keaveny
authors.affiliation: Mayo Clinic Collaborative in Transplant Research and Outcomes, Department of Transplant. Mayo Clinic Florida. USA.
authors.forename: C Burcin
authors.initials: CB
authors.lastname: Taner
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000410:Alanine Transaminase / Q000097:blood; D064591:Allografts; D001219:Aspartate Aminotransferases / Q000097:blood; D001663:Bilirubin / Q000097:blood; D015415:Biomarkers / Q000097:blood; D016009:Chi-Square Distribution; D002648:Child; D002675:Child, Preschool; D004796:Clinical Enzyme Tests; D005260:Female; D005431:Florida / Q000453:epidemiology; D006085:Graft Survival; D006801:Humans; D015994:Incidence; D019934:International Normalized Ratio; D053208:Kaplan-Meier Estimate; D007902:Length of Stay; D016031:Liver Transplantation / Q000009:adverse effects* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011237:Predictive Value of Tests; D055031:Primary Graft Dysfunction / Q000097:blood / Q000175:diagnosis / Q000209:etiology* / Q000401:mortality / Q000628:therapy; D016016:Proportional Hazards Models; D058996:Quality Improvement; D019984:Quality Indicators, Health Care; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D015415:Biomarkers; D001219:Aspartate Aminotransferases; D000410:Alanine Transaminase; D001663:Bilirubin