Early Allograft Dysfunction After Live Donor Liver Transplantation: It's Time to Redefine?

Abstract

Background: An ideal definition of early allograft dysfunction (EAD) after live donor liver transplantation (LDLT) remains elusive. The aim of the present study was to compare the diagnostic accuracies of existing EAD definitions, identify the predictors of early graft loss due to EAD, and formulate a new definition, estimating EADrelated mortality in LDLT recipients. Methods: Consecutive adult patients undergoing elective LDLT were analyzed. Patients with technical (vascular, biliary) complications and biopsy-proven rejections were excluded. Results: There were 19 deaths due to EAD of a total of 304 patients. On applying the existing definitions of EAD, we revealed their limitations of being either too broad with low specificity or too restrictive with low sensitivity in patients with LDLT. A new definition of EAD-LDLT (total bilirubin >10 mg/dL, international normalized ratio [INR] > 1.6 and serum urea >100 mg/dL, for five consecutive days after day 7) was derived after doing a multivariate analysis. In receiver operator characteristics analysis, an AUC for EAD-LDLT was 0.86. The calibration and internal cross-validation of the new model confirmed its predictability. Conclusion: The new model of EAD-LDLT, based on total bilirubin >10 mg/dL, INR >1.6 and serum urea >100 mg/dL, for five consecutive days after day 7, has a better predictive value for mortality due to EAD in LDLT recipients. ( J CLIN EXP HEPATOL xxxx;xxx:xxx)

Lifestyle Optimization Leads to Superior Liver Regeneration in Live Liver Donors and Decreases Early Allograft Dysfunction in Recipients

“…For the recipients, our immunosuppression protocol consisted of methylprednisolone induction in the anhepatic phase followed by tacrolimus+mycophenolate mofetil+prednisolone as maintenance immunotherapy 5 . Complications were evaluated using a modified Clavien’s grading system, 6 and EGD was defined as per our already published criteria 7,8 . We do not have a separate step-down unit, thus ICU and HDU stay are the same.…”

“…5 Complications were evaluated using a modified Clavien's grading system, 6 and EGD was defined as per our already published criteria. 7,8 We do not have a separate step-down unit, thus ICU and HDU stay are the same.…”

Early allograft dysfunction after living donor liver transplantation—current concepts and future directions

“…In a study, serum urea level > 100 mg/dL after POD 7 for 5 consecutive days was independently associated with early graft loss in multivariate analysis. [14] A low post-LT platelet count and a slower rate of increase can predict EAD and graft failure. The degree of platelet consumption is related to the severity of endothelial cell damage, and recent studies have incorporated postoperative platelet counts into a measure of EAD.…”

“…Most post-LT patients present with some early graft dysfunction, with a varying incidence between 12% and 35% 1,8,11,13,14 . In DDLT, using extended criteria donors to expand the donor pool strategically has increased the risk of EAD and PNF 16–20 .…”

Post Living Donor Liver Transplantation Small-for-size Syndrome: Definitions, Timelines, Biochemical, and Clinical Factors for Diagnosis: Guidelines From the ILTS-iLDLT-LTSI Consensus Conference

“…Additionally, serum urea level of >100 mg/dL for 5 consecutive days is proposed to increase the diagnostic accuracy of SFSS for predicting graft loss (area under the curve = 0.86), although external validation is warranted. 77 Overall, based on the available literature, total bilirubin and INR are the essential biochemical factors, with massive ascites being a specific clinical factor for the definition of SFSS after LDLT. Preexisting hyperbilirubinemia or ascites before transplantation should be taken into account when diagnosing SFSS if conditions do not improve.…”