title: High serum Aspartate transaminase levels on day 3 postliver transplantation correlates with graft and patient survival and would be a valid surrogate for outcome in liver transplantation clinical trials.
abstract: Aspartate transaminase, a liver specific enzyme released into serum following acute liver injury, is used in experimental organ preservation studies as a measure of liver IR injury. Whether post-operative serum transaminases are a good indicator of IR injury and subsequent graft and patient survival in human liver transplantation remains controversial. A single centre prospectively collected liver transplant database was analysed for the period 1988-2012. All patients were followed up for 5 years or until graft failure. Transaminase levels on the 1st, 3rd and 7th post-operative days were correlated with the patient demographics, operative outcomes, post-operative complications and both graft and patient survival via a binary logistic regression analysis. Graft and patient survival at 3 months was 80.3% and 87.5%. AST levels on the 3rd (P = 0.005) and 7th (P = 0.001) post-operative days correlated with early graft loss. Patients were grouped by their AST level (day 3): <107iU, 107-1213iU, 1213-2744iU and >2744iU. The incidence of graft loss at 3 months was 10%, 12%. 27% and 59% and 1-year patient mortality was 12%, 14%, 27% and 62%. Day 3 AST levels correlate with patient and graft outcome post-liver transplantation and would be a suitable surrogate endpoint for clinical trials in liver transplantation.
authors.affiliation: Division of Surgery and Interventional Science, Royal Free Campus, University College London (UCL), London, UK.
authors.forename: Francis P
authors.initials: FP
authors.lastname: Robertson
authors.affiliation: School of Veterinary Medicine, Roslyn Institute, University of Edinburgh, Easter Bush, Edinburgh, Midlothian, UK.
authors.forename: Paul R
authors.initials: PR
authors.lastname: Bessell
authors.affiliation: HPB and Liver Transplant Unit, Royal Free London NHS Foundation Trust, London, UK.
authors.forename: Rafael
authors.initials: R
authors.lastname: Diaz-Nieto
authors.affiliation: Division of Surgery and Interventional Science, Royal Free Campus, University College London (UCL), London, UK.
authors.forename: Niclas
authors.initials: N
authors.lastname: Thomas
authors.affiliation: HPB and Liver Transplant Unit, Royal Free London NHS Foundation Trust, London, UK.
authors.forename: Nancy
authors.initials: N
authors.lastname: Rolando
authors.affiliation: Division of Surgery and Interventional Science, Royal Free Campus, University College London (UCL), London, UK.
authors.forename: Barry
authors.initials: B
authors.lastname: Fuller
authors.affiliation: Division of Surgery and Interventional Science, Royal Free Campus, University College London (UCL), London, UK.|HPB and Liver Transplant Unit, Royal Free London NHS Foundation Trust, London, UK.
authors.forename: Brian R
authors.initials: BR
authors.lastname: Davidson
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001219:Aspartate Aminotransferases / Q000097:blood*; D002648:Child; D002986:Clinical Trials as Topic; D005260:Female; D006085:Graft Survival; D006801:Humans; D016031:Liver Transplantation / Q000401:mortality*; D008131:London / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D011184:Postoperative Period; D011446:Prospective Studies; D055815:Young Adult
chemical_list: D001219:Aspartate Aminotransferases
keywords: AST; graft loss; liver transplantation; mortality; outcome; surrogate endpoint