title: Effect of early allograft dysfunction on outcomes following liver transplantation.
abstract: Early allograft dysfunction (EAD) following liver transplantation (LT) remains a challenge for patients and clinicians. We retrospectively analyzed the effect of pre-defined EAD on outcomes in a 10-year cohort of deceased-donor LT recipients with clearly defined exclusion criteria. EAD was defined by at least one of the following: AST or ALT >2000 IU/L within first-week post-LT, total bilirubin ≥10 mg/dL, and/or INR ≥1.6 on post-operative day 7. Ten patients developed primary graft failure and were analyzed separately. EAD occurred in 86 (36%) recipients in a final cohort of 239 patients. In univariate and multivariate analyses, EAD was significantly associated with mechanical ventilation ≥2 days or death on days 0, 1, PACU/SICU stay >2 days or death on days 0-2 and renal failure (RF) at time of hospital discharge (all P<.05). EAD was also significantly associated with higher one-year graft loss in both uni- and multivariate Cox hazard analyses (P=.0203 and .0248, respectively). There was no difference in patient mortality between groups in either of the Cox proportional hazard models. In conclusion, we observed significant effects of EAD on short-term post-LT outcomes and lower graft survival.
authors.affiliation: Department of Surgical Critical Care, Lahey Hospital and Medical Center, Burlington, MA, USA.|Tufts University School of Medicine, Boston, MA, USA.
authors.forename: Jana
authors.initials: J
authors.lastname: Hudcova
authors.affiliation: Lahey Hospital and Medical Center Burlington, Burlington, MA, USA.
authors.forename: Caitlin
authors.initials: C
authors.lastname: Scopa
authors.affiliation: Tufts Medical Center, Boston, MA, USA.
authors.forename: Jawad
authors.initials: J
authors.lastname: Rashid
authors.affiliation: Lahey Hospital and Medical Center Burlington, Burlington, MA, USA.
authors.forename: Ahsan
authors.initials: A
authors.lastname: Waqas
authors.affiliation: Biostatistics, Epidemiology, and Research Design (BERD) Center at Tufts Medical Center, Boston, MA, USA.
authors.forename: Robin
authors.initials: R
authors.lastname: Ruthazer
authors.affiliation: Tufts Medical Center, Boston, MA, USA.
authors.forename: Roman
authors.initials: R
authors.lastname: Schumann
mesh_terms: D000328:Adult; D064591:Allografts; D001900:Boston / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000453:epidemiology* / Q000209:etiology; D006085:Graft Survival; D006801:Humans; D015994:Incidence; D016031:Liver Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D055031:Primary Graft Dysfunction / Q000453:epidemiology* / Q000209:etiology; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors
keywords: deceased donor; duration of intubation; graft and patient survival; hospital length of stay; multivariate logistic regression; post-transplant renal failure; postoperative recovery; primary graft failure; univariate logistic regression