title: Improving the Diagnostic Criteria for Primary Liver Graft Nonfunction in Adults Utilizing Standard and Transportable Laboratory Parameters: An Outcome-Based Analysis.
abstract: Current diagnostic criteria for primary nonfunction (PNF) of liver grafts are based on clinical experience rather than statistical methods. A retrospective, single-center study was conducted of all adults (n = 1286) who underwent primary liver transplant (LT) 2000-2008 in our center. Laboratory variables during the first post LT week were analyzed. Forty-two patients (3.7%) had 2-week graft failure. Transplant albumin, day-1 aspartate aminotransferase (AST), day-1 lactate, day-3 bilirubin, day-3 international normalized ratio (INR), and day-7 AST were independently associated with PNF on multivariate logistic regression. PNF score =(0.000280*D1AST)+ (0.361*D1 Lactate)+(0.00884*D3 Bilirubin)+(0.940*D3 INR)+(0.00153*D7 AST)-(0.0972*TxAlbumin)-4.5503. Receiver operating curve analysis showed the model area under receiver operating curve (AUROC) of 0.912 (0.889-0.932) was superior to the current United Kingdom (UK) PNF criteria of 0.669 (0.634-0.704, p < 0.0001). When applied to a validation cohort (n = 386, 34.4% patients), the model had AUROC of 0.831 (0.789-0.867) compared to the UK early graft dysfunction criteria of 0.674 (0.624-0.721). The new model performed well after exclusion of patients with marginal grafts and when modified to include variables from the first three post-LT days only (AUROC of 0.818, 0.776-0.856, p = 0.001). This model is superior to the current UK PNF criteria and is based on statistical methods. The model is also applicable to recipients of all types of grafts (marginal and nonmarginal).
authors.affiliation: Institute of Liver Studies, King's College Hospital, London, UK.
authors.forename: M A B
authors.initials: MAB
authors.lastname: Al-Freah
authors.affiliation: Institute of Liver Studies, King's College Hospital, London, UK.
authors.forename: M J W
authors.identifier: http://orcid.org/0000-0001-5449-2424
authors.initials: MJW
authors.lastname: McPhail
authors.affiliation: Institute of Liver Studies, King's College Hospital, London, UK.
authors.forename: E
authors.initials: E
authors.lastname: Dionigi
authors.affiliation: Institute of Liver Studies, King's College Hospital, London, UK.
authors.forename: M R
authors.initials: MR
authors.lastname: Foxton
authors.affiliation: Institute of Liver Studies, King's College Hospital, London, UK.
authors.forename: G
authors.initials: G
authors.lastname: Auzinger
authors.affiliation: Institute of Liver Studies, King's College Hospital, London, UK.
authors.forename: M
authors.initials: M
authors.lastname: Rela
authors.affiliation: Institute of Liver Studies, King's College Hospital, London, UK.
authors.forename: J A
authors.initials: JA
authors.lastname: Wendon
authors.affiliation: Institute of Liver Studies, King's College Hospital, London, UK.
authors.forename: J G
authors.initials: JG
authors.lastname: O'Grady
authors.affiliation: Institute of Liver Studies, King's College Hospital, London, UK.
authors.forename: M A
authors.initials: MA
authors.lastname: Heneghan
authors.affiliation: Institute of Liver Studies, King's College Hospital, London, UK.
authors.forename: N D
authors.initials: ND
authors.lastname: Heaton
authors.affiliation: Institute of Liver Studies, King's College Hospital, London, UK.
authors.forename: W
authors.initials: W
authors.lastname: Bernal
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D051799:Delayed Graft Function / Q000175:diagnosis* / Q000209:etiology; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000175:diagnosis* / Q000209:etiology; D006085:Graft Survival; D006801:Humans; D016031:Liver Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000175:diagnosis*; D011379:Prognosis; D012372:ROC Curve; D012189:Retrospective Studies; D012720:Severity of Illness Index; D055815:Young Adult
keywords: clinical research/practice; liver allograft function/dysfunction; liver transplantation/hepatology; liver transplantation: auxiliary; liver transplantation: living donor; liver transplantation: split