Predicting early allograft failure and mortality after liver transplantation: The role of the postoperative model for end-stage liver disease score

Abstract

Early allograft dysfunction (EAD) is a serious complication after liver transplantation (LT).There is no uniform definition of EAD, and most definitions are based on arbitrary laboratory values. The aim of this study was to devise a definition of EAD that maximizes the predictive power for early death and graft failure. In this single-center, retrospective study, the ability of the international normalized ratio (INR), total bilirubin, aspartate aminotransferase (AST), physiological Model for End-Stage Liver Disease (MELD) score, and serum albumin levels within 7 days after LT to predict 90-day mortality or graft loss was compared with 2 previously used definitions of EAD: (1) peak total bilirubin level >10 mg/dL on days 2 to 7 and (2) either a total bilirubin level >10 mg/dL or an INR >1.6 on day 7 or an AST or alanine aminotransferase level >2000 IU/L within the first 7 days. Of 572 enrolled LT patients 38 died or required retransplantation within 90 days. Peak INR, total bilirubin level, AST levels, and MELD scores were predictors of 90-day graft failure. MELD score on postoperative day 5 was the best predictor with an area under the curve of the receiver operating characteristic curve of 0.812 (95% CI: 0.739-0.886, P < 0.001). The best cutoff of MELD score on day 5 for predicting 90-day mortality or graft loss was 18.9. A MELD score >18.9 on postoperative day 5 was a better predictor than any other laboratory value or definition of EAD. This study has demonstrated that the MELD score can be a useful tool not only for pretransplant graft allocation but also for postoperative risk stratification.

Early allograft dysfunction in liver transplantation using donation after cardiac death donors results in inferior survival

“…1 A previous publication from a single institution reported an incidence of 39.8%, but the breakdown of DCD and DBD allografts was not reported. 21 The University of Western Ontario reported a series of 38 recipients of DCD allografts, among whom 26 (68%) met the criteria for EAD. 13 In its comparative cohort of DBD recipients, only 19 of 89 (21%) met the criteria for EAD.…”

Primary graft dysfunction of the liver: definitions, diagnostic criteria and risk factors

“…The value of the MELD score in predicting EAD within the first week, or mortality within 90 days post-transplant, was emphasized by Wagener et al (20) A study involving 66 transplanted patients (21) suggested peak serum AST investigation should be performed within the 5-11-hour post-reperfusion time window, given AST levels are known to drop by half within the first postoperative day. (21) This finding is highly significant, bearing in mind the lack of a consensus among organ transplant centers as to the best time point for the first serum AST level determination.…”

MELD score measured day 10 after orthotopic liver transplantation predicts death and re-transplantation within the first year

“…Early post-transplant prognostic scores are of greater value, and several has previously been evaluated (12,13,(15)(16)(17). The most easily applicable score with a good predictive value is the post-transplant MELD score.…”

“…The pre-transplant MELD score predicts death on the waiting list, but poorly predicts outcome after liver transplantation (6)(7)(8)(9)(10)(11). In contrast, the MELD score measured early after liver transplantation, has been found to be a reasonable predictor of 3-month mortality and maybe superior to other prognostic scores, although it remains unknown whether the prognostic value of the MELD score persists if the association is adjusted for known risk-factors of a poor outcome (12)(13)(14)(15)(16)(17)(18).…”