Early liver allograft dysfunction: risk factors, clinical course and outcomes
Early liver allograft dysfunction (EAD) is associated with a high incidence of graft loss and patient mortality in the first 6 weeks after orthotopic liver transplantation (OLT).The aim of this retrospective single-center study is to identify the risk factors of EAD and to compare the short- and lon...
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N.V. Sklifosovsky Research Institute for Emergency Medicine of Moscow Healthcare Department
2016-06-01
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| Series: | Трансплантология (Москва) |
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| Online Access: | https://www.jtransplantologiya.ru/jour/article/view/119 |
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| author | Ya. G. Moysyuk V. N. Poptsov A. I. Sushkov L. Ya. Moysyuk Yu. O. Malinovskaya L. V. Belskikh |
| author_facet | Ya. G. Moysyuk V. N. Poptsov A. I. Sushkov L. Ya. Moysyuk Yu. O. Malinovskaya L. V. Belskikh |
| author_sort | Ya. G. Moysyuk |
| collection | DOAJ |
| description | Early liver allograft dysfunction (EAD) is associated with a high incidence of graft loss and patient mortality in the first 6 weeks after orthotopic liver transplantation (OLT).The aim of this retrospective single-center study is to identify the risk factors of EAD and to compare the short- and long-term results in EAD and non-EAD groups.Materials and methods. The results of 213 consecutive deceased donor liver transplantations performed between December 2004 and February 2015 were included in the analysis. Indications for OLT were non-viral liver cirrhosis in 52% of cases, viral hepatitis C or B in 34 %, hepatocellular carcinoma in 8 %; retransplantations were performed in 6% of cases due to previous liver graft dysfunction. EAD was defined by Olthoff criteria (Olthoff et al., 2010).Results. Overall incidence of EAD was 41.3%, including 5.6% of primary non-function grafts (PNF), i.e. irreversible EAD. No significant differences between EAD and non-EAD groups were seen either among donors in their age, gender, cause of death, bilirubin, plasma sodium level, aminotransferases aktivity, or among the recipients in their age, gender, body mass index, MELD. Retransplantation, donor time on mechanical ventilation in the intensive care unit for more than 2 days, highrisk donor category, transplant surgery duration more than 9.5 hours, and cold ischemia time (CIT) > 8 hours were independent significant risk factors of EAD in a multivariate model. A 42-day mortality rates were 18.2% in EAD group (mostly due to PNF without urgent retransplantanion in 9.1%), and 0% in non-EAD group. Long-term results in EAD group were also significantly poorer: 1-, 5-, and 10-year graft survival rates were 74%, 68%, and 64%, respectively, versus 96%, 90%, and 83% in non-EAD group, Log-rank p = 0.0001.Conclusion. EAD significantly (≈ 20%) decreases the short-term graft and patient survival rates. Meanwhile, a reversible EAD has no impact on long-term results. Despite the increased risk of EAD, the liver grafts from high-risk donors are suitable for transplantation. The most important and modifiable risk factor is CIT (optimal timeframe 6 - 8 h), especially when HTK solution is used. The risk of EAD / PNF dramatically increases in case of combined donor and recipient risk factors. |
| format | Article |
| id | doaj-art-701c438fe9b143dbae608f143df1e9f0 |
| institution | DOAJ |
| issn | 2074-0506 2542-0909 |
| language | English |
| publishDate | 2016-06-01 |
| publisher | N.V. Sklifosovsky Research Institute for Emergency Medicine of Moscow Healthcare Department |
| record_format | Article |
| series | Трансплантология (Москва) |
| spelling | doaj-art-701c438fe9b143dbae608f143df1e9f02025-08-20T02:55:45ZengN.V. Sklifosovsky Research Institute for Emergency Medicine of Moscow Healthcare DepartmentТрансплантология (Москва)2074-05062542-09092016-06-01021628119Early liver allograft dysfunction: risk factors, clinical course and outcomesYa. G. Moysyuk0V. N. Poptsov1A. I. Sushkov2L. Ya. Moysyuk3Yu. O. Malinovskaya4L. V. Belskikh5Moscow Regional Research and Clinical Institute named after M.F. VladimirskyAcademician V.I. Shumakov Federal Research Center of Transplantology and Artificial Organs of the Ministry of Healthcare of the Russian Federation, MoscowAcademician V.I. Shumakov Federal Research Center of Transplantology and Artificial Organs of the Ministry of Healthcare of the Russian Federation, MoscowAcademician V.I. Shumakov Federal Research Center of Transplantology and Artificial Organs of the Ministry of Healthcare of the Russian Federation, MoscowMoscow Regional Research and Clinical Institute named after M.F. VladimirskyMoscow Regional Research and Clinical Institute named after M.F. VladimirskyEarly liver allograft dysfunction (EAD) is associated with a high incidence of graft loss and patient mortality in the first 6 weeks after orthotopic liver transplantation (OLT).The aim of this retrospective single-center study is to identify the risk factors of EAD and to compare the short- and long-term results in EAD and non-EAD groups.Materials and methods. The results of 213 consecutive deceased donor liver transplantations performed between December 2004 and February 2015 were included in the analysis. Indications for OLT were non-viral liver cirrhosis in 52% of cases, viral hepatitis C or B in 34 %, hepatocellular carcinoma in 8 %; retransplantations were performed in 6% of cases due to previous liver graft dysfunction. EAD was defined by Olthoff criteria (Olthoff et al., 2010).Results. Overall incidence of EAD was 41.3%, including 5.6% of primary non-function grafts (PNF), i.e. irreversible EAD. No significant differences between EAD and non-EAD groups were seen either among donors in their age, gender, cause of death, bilirubin, plasma sodium level, aminotransferases aktivity, or among the recipients in their age, gender, body mass index, MELD. Retransplantation, donor time on mechanical ventilation in the intensive care unit for more than 2 days, highrisk donor category, transplant surgery duration more than 9.5 hours, and cold ischemia time (CIT) > 8 hours were independent significant risk factors of EAD in a multivariate model. A 42-day mortality rates were 18.2% in EAD group (mostly due to PNF without urgent retransplantanion in 9.1%), and 0% in non-EAD group. Long-term results in EAD group were also significantly poorer: 1-, 5-, and 10-year graft survival rates were 74%, 68%, and 64%, respectively, versus 96%, 90%, and 83% in non-EAD group, Log-rank p = 0.0001.Conclusion. EAD significantly (≈ 20%) decreases the short-term graft and patient survival rates. Meanwhile, a reversible EAD has no impact on long-term results. Despite the increased risk of EAD, the liver grafts from high-risk donors are suitable for transplantation. The most important and modifiable risk factor is CIT (optimal timeframe 6 - 8 h), especially when HTK solution is used. The risk of EAD / PNF dramatically increases in case of combined donor and recipient risk factors.https://www.jtransplantologiya.ru/jour/article/view/119liver transplantationprimary graft dysfunctionsurvival |
| spellingShingle | Ya. G. Moysyuk V. N. Poptsov A. I. Sushkov L. Ya. Moysyuk Yu. O. Malinovskaya L. V. Belskikh Early liver allograft dysfunction: risk factors, clinical course and outcomes Трансплантология (Москва) liver transplantation primary graft dysfunction survival |
| title | Early liver allograft dysfunction: risk factors, clinical course and outcomes |
| title_full | Early liver allograft dysfunction: risk factors, clinical course and outcomes |
| title_fullStr | Early liver allograft dysfunction: risk factors, clinical course and outcomes |
| title_full_unstemmed | Early liver allograft dysfunction: risk factors, clinical course and outcomes |
| title_short | Early liver allograft dysfunction: risk factors, clinical course and outcomes |
| title_sort | early liver allograft dysfunction risk factors clinical course and outcomes |
| topic | liver transplantation primary graft dysfunction survival |
| url | https://www.jtransplantologiya.ru/jour/article/view/119 |
| work_keys_str_mv | AT yagmoysyuk earlyliverallograftdysfunctionriskfactorsclinicalcourseandoutcomes AT vnpoptsov earlyliverallograftdysfunctionriskfactorsclinicalcourseandoutcomes AT aisushkov earlyliverallograftdysfunctionriskfactorsclinicalcourseandoutcomes AT lyamoysyuk earlyliverallograftdysfunctionriskfactorsclinicalcourseandoutcomes AT yuomalinovskaya earlyliverallograftdysfunctionriskfactorsclinicalcourseandoutcomes AT lvbelskikh earlyliverallograftdysfunctionriskfactorsclinicalcourseandoutcomes |