title: Predictive factors of short term outcome after liver transplantation: A review.
abstract: Liver transplantation represents a fundamental therapeutic solution to end-stage liver disease. The need for liver allografts has extended the set of criteria for organ acceptability, increasing the risk of adverse outcomes. Little is known about the early postoperative parameters that can be used as valid predictive indices for early graft function, retransplantation or surgical reintervention, secondary complications, long intensive care unit stay or death. In this review, we present state-of-the-art knowledge regarding the early post-transplantation tests and scores that can be applied during the first postoperative week to predict liver allograft function and patient outcome, thereby guiding the therapeutic and surgical decisions of the medical staff. Post-transplant clinical and biochemical assessment of patients through laboratory tests (platelet count, transaminase and bilirubin levels, INR, factor V, lactates, and Insulin Growth Factor 1) and scores (model for end-stage liver disease, acute physiology and chronic health evaluation, sequential organ failure assessment and model of early allograft function) have been reported to have good performance, but they only allow late evaluation of patient status and graft function, requiring days to be quantified. The indocyanine green plasma disappearance rate has long been used as a liver function assessment technique and has produced interesting, although not univocal, results when performed between the 1(th) and the 5(th) day after transplantation. The liver maximal function capacity test is a promising method of metabolic liver activity assessment, but its use is limited by economic cost and extrahepatic factors. To date, a consensual definition of early allograft dysfunction and the integration and validation of the above-mentioned techniques, through the development of numerically consistent multicentric prospective randomised trials, are necessary. The medical and surgical management of transplanted patients could be greatly improved by using clinically reliable tools to predict early graft function.
authors.affiliation: Giuliano Bolondi, Anaesthesiology, Intensive Care and Pain Therapy Medical Residency, University of Modena and Reggio Emilia, 41124 Modena, Italy.
authors.forename: Giuliano
authors.initials: G
authors.lastname: Bolondi
authors.affiliation: Giuliano Bolondi, Anaesthesiology, Intensive Care and Pain Therapy Medical Residency, University of Modena and Reggio Emilia, 41124 Modena, Italy.
authors.forename: Federico
authors.initials: F
authors.lastname: Mocchegiani
authors.affiliation: Giuliano Bolondi, Anaesthesiology, Intensive Care and Pain Therapy Medical Residency, University of Modena and Reggio Emilia, 41124 Modena, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Montalti
authors.affiliation: Giuliano Bolondi, Anaesthesiology, Intensive Care and Pain Therapy Medical Residency, University of Modena and Reggio Emilia, 41124 Modena, Italy.
authors.forename: Daniele
authors.initials: D
authors.lastname: Nicolini
authors.affiliation: Giuliano Bolondi, Anaesthesiology, Intensive Care and Pain Therapy Medical Residency, University of Modena and Reggio Emilia, 41124 Modena, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Vivarelli
authors.affiliation: Giuliano Bolondi, Anaesthesiology, Intensive Care and Pain Therapy Medical Residency, University of Modena and Reggio Emilia, 41124 Modena, Italy.
authors.forename: Lesley
authors.initials: L
authors.lastname: De Pietri
mesh_terms: D018806:APACHE; D000410:Alanine Transaminase / Q000097:blood; D001219:Aspartate Aminotransferases / Q000097:blood; D001663:Bilirubin / Q000097:blood; D004396:Coloring Agents; D058625:End Stage Liver Disease; D005165:Factor V / Q000378:metabolism; D006801:Humans; D007208:Indocyanine Green; D007334:Insulin-Like Growth Factor I / Q000378:metabolism; D019934:International Normalized Ratio; D007773:Lactates / Q000097:blood; D008111:Liver Function Tests; D016031:Liver Transplantation; D063305:Organ Dysfunction Scores; D010976:Platelet Count; D055031:Primary Graft Dysfunction / Q000097:blood / Q000453:epidemiology* / Q000378:metabolism; D011379:Prognosis; D012086:Reoperation; D012720:Severity of Illness Index
chemical_list: D004396:Coloring Agents; C583557:IGF1 protein, human; D007773:Lactates; D007334:Insulin-Like Growth Factor I; D005165:Factor V; D001219:Aspartate Aminotransferases; D000410:Alanine Transaminase; D007208:Indocyanine Green; D001663:Bilirubin
keywords: Early allograft dysfunction; Indocyanine green; Initial poor function; Liver failure; Liver maximal functional capacity; Liver transplant; Outcome predictors; Post operative; Primary non-function; Scoring system