Predictive factors of short term outcome after liver transplantation: A review

Abstract

Liver transplantation represents a fundamental therapeutic solution to end-stage liver disease. The need for liver allografts has extended the set of criteria for organ acceptability, increasing the risk of adverse outcomes. Little is known about the early postoperative parameters that can be used as valid predictive indices for early graft function, retransplantation or surgical reintervention, secondary complications, long intensive care unit stay or death. In this review, we present state-of-the-art knowledge regarding the early post-transplantation tests and scores that can be applied during the first postoperative week to predict liver allograft function and patient outcome, thereby guiding the therapeutic and surgical decisions of the medical staff. Post-transplant clinical and biochemical assessment of patients through laboratory tests (platelet count, transaminase and bilirubin levels, INR, factor V, lactates, and Insulin Growth Factor 1) and scores (model for end-stage liver disease, acute physiology and chronic health evaluation, sequential organ failure assessment and model of early allograft function) have been reported to have good performance, but they only allow late evaluation of patient status and graft function, requiring days to be quantified. The indocyanine green plasma disappearance rate has long been used as a liver function assessment technique and has produced interesting, although not univocal, results when performed between the 1(th) and the 5(th) day after transplantation. The liver maximal function capacity test is a promising method of metabolic liver activity assessment, but its use is limited by economic cost and extrahepatic factors. To date, a consensual definition of early allograft dysfunction and the integration and validation of the above-mentioned techniques, through the development of numerically consistent multicentric prospective randomised trials, are necessary. The medical and surgical management of transplanted patients could be greatly improved by using clinically reliable tools to predict early graft function.

Peri‐transplant lactate levels and delayed lactate clearance as predictive factors for poor outcomes after liver transplantation: A propensity score–matched study

“…The rate of graft loss was reported to be 26.1% for patients with EAD compared to 3.5% for patients without EAD. In addition, EAD is associated with longer intensive care unit and hospital stay due to postoperative complications such as renal failure, severe bleeding, and septic infection, which profoundly compromised graft and patient survival . In this study, EAD occurred in 29%, which is compatible with reported incidences of 18.3%‐36.3% .…”

“…We investigated an association between lactate clearance and occurrence of EAD, because several studies have validated the accuracy and usefulness of EAD criteria introduced by Olthoff, et al in 2010 to predict liver transplant outcomes . It is well known that EAD was associated with early morbidity and mortality following LT . Olthoff reported that 18.8% of the recipients with EAD died, whereas only 1.8% without EAD died.…”

Ischaemia reperfusion injury in liver transplantation: Cellular and molecular mechanisms

“…Thus, organs at high risk for IRI, when put into recipients primed for ischaemic injury, can lead to a potentially catastrophic scenario. Understanding IRI is, therefore, critical to success in liver transplantation …”

“…Understanding IRI is, therefore, critical to success in liver transplantation. 6 Liver IRI involves many cellular compartments. Liver sinusoidal endothelial cells and hepatocytes are targets of IRI-induced cell death.Early IRI-induced cell death is a result of metabolic disturbances and ATP depletion.…”

Evaluation of the perioperative period of orthotopic liver transplantation with veno-venous bypass and without it

“…У пациентов второй группы вено венозная гемодиафильтрация с ультрафильтрацией проводилась в качестве подготовки к реконструк ции веновенозного анастомоза. Развитие обрати мой ранней дисфункции трансплантата (по кри териям Olthoff) было отмечено у трех пациентов (11,5%) второй группы с использованием ВВОШ (в одном случае -АЛТ более 2000 Ед/л в течение первых 7 суток после ОТП; в двух случаях -МНО > 1,6 на 7е сутки после ОТП) [13]. В первой группе не отмечалось хирургических осложнений.…”