Early allograft dysfunction (EAD) dramatically influences graft and patient outcomes. A lack of consensus on an EAD definition hinders comparisons of liver transplant outcomes and management of recipients among and within centers. We sought to develop a model for the quantitative assessment of early allograft function [Model for Early Allograft Function Scoring (MEAF)] after transplantation. A retrospective study including 1026 consecutive liver transplants was performed for MEAF score development. Multivariate data analysis was used to select a small number of postoperative variables that adequately describe EAD. Then, the distribution of these variables was mathematically modeled to assign a score for each actual variable value. A model, based on easily obtainable clinical parameters (ie, alanine aminotransferase, international normalized ratio, and bilirubin) and scoring liver function from 0 to 10, was built. The MEAF score showed a significant association with patient and graft survival at 3-, 6-and 12-month follow-ups. Hepatic steatosis and age for donors; cold/warm ischemia times and postreperfusion syndrome for surgery; and intensive care unit and hospital stays, Model for End-Stage Liver Disease and Child-Pugh scores, body mass index, and fresh frozen plasma transfusions for recipients were factors associated significantly with EAD. The model was satisfactorily validated by its application to an independent set of 200 patients who underwent liver transplantation at a different center. In conclusion, a model for the quantitative assessment of EAD severity has been developed and validated for the first time. The MEAF provides a more accurate graft function assessment than current categorical classifications and may help clinicians to make early enough decisions on retransplantation benefits. Furthermore, the MEAF score is a predictor of recipient and graft survival. The standardization of the criteria used to define EAD may allow reliable comparisons of recipients' treatments and transplant outcomes among and within centers. Liver Transpl 21:38-46, 2015. V C 2014 AASLD.Received March 4, 2014; accepted September 2, 2014.Additional Supporting Information may be found in the online version of this article.Abbreviations: ALT, alanine aminotransferase; ALT max.3POD , maximum alanine aminotransferase value during the first 3 postoperative days; AST, aspartate aminotransferase; AUC, area under the curve; BIC, Bayesian information criterion; bilirubin 3POD , bilirubin value on day 3 after liver transplantation; CI, confidence interval; CIT, cold ischemia time; EAD, early allograft dysfunction; ECDF, empirical cumulative distribution function; ICU, intensive care unit; INR, international normalized ratio; INR max.3POD , maximum international normalized ratio during the first 3 postoperative days; MEAF, Model for Early Allograft Function Scoring; MELD, Model for End-Stage Liver Disease; OLT, orthotopic liver transplantation; PNF, primary nonfunction; POD, postoperative day; PT, prothrombin time; RI, relative import...

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Orthotopic liver transplantation (OLT) selection for patients with hepatocellular carcinoma (HCC) is a matter of debate. The Milan criteria (MC) have been largely adopted by the international community. The main aim of this study was to evaluate the survival rates and recurrence probabilities of a new proposal for criteria (up to 3 tumors, each no larger than 5 cm, and a cumulative tumor burden Յ 10 cm). Patients with cirrhosis and HCC included on the waiting list (WL) from 1991 to 2006 were retrospectively analyzed. Outcomes in patients who had tumors within and beyond the MC were compared. The survival analysis was done (1) with the intention-to-treat principle and (2) among transplanted patients. A total of 281 patients were included in WL. Twenty-four cases did not undergo OLT (a dropout rate of 8.5%); all but 1 case had tumors within the MC. Of the 257 transplanted patients, 26 had tumors beyond the MC in the pre-OLT evaluation. Based on the intention-to-treat analysis, the 5-year survival was 56% versus 66% in patients who had tumors within and beyond the MC, respectively (P ϭ 0.487). Among transplanted patients, the 5-year survival was 62% versus 69%, respectively (P ϭ 0.734). Through multivariate analysis, microvascular invasion was an independent prognostic factor of poor survival (P ϭ 0.004). The recurrence probabilities at 1 and 5 years were 7% versus 12% and 14% versus 28% in patients with tumors within and beyond the MC, respectively (P ϭ 0.063). The multivariate analysis demonstrated that both poorly differentiated tumors (P Ͻ 0.001) and microvascular invasion (P Ͻ 0.001) increased the risk of recurrence. The expansion to up to 3 nodules, each up to 5 cm, and a cumulative tumor burden Յ 10 cm did not result in a reduction of survival in comparison with patients who had tumors within the MC.