Significance of Early Aminotransferase Elevation After Liver Transplantation1

Abstract

We conclude that: (1) patient survival is influenced by IPRI only when it is extreme (ASTmax>5000 U/L), provided parameters of graft function are used in conjunction with aminotransferase values to assess the need for prompt retransplantation; (2) short-term graft survival is proportional to the extent of IPRI, but grafts that are not lost to PNF have equivalent 1- and 2-year survival irrespective of the magnitude of IPRI; (3) 40% of grafts with extreme IPRI are lost to PNF, but the same proportion also provide long-term function; and (4) for surviving grafts, long-term biochemical function as well as the incidence of biliary complications and of chronic rejection are unrelated to the extent of IPRI.

Molecular adsorbent recirculating system in patients with early allograft dysfunction after liver transplantation: A pilot study

“…In previous studies, mortality rates have been shown to range 18-59%, according to definition of EAD or severity of liver graft injury. [18][19][20]26 Published one-year graft survival rates of 27-62% are lower than in our study population. Because our study was not performed in a randomized, controlled manner, we cannot speculate whether MARS treatment improved mortality in our patient population.…”

“…Transaminase activity levels represent a well-established parameter for the estimation of hepatic injury after OLT, and some studies have implicated AST as a determinant of higher patient mortality. 17,18 However, AST levels alone were not found to be predictive of the occurrence of EAD. 16 Rosen et al 18 demonstrated that patient survival is not influenced by ischemia-reperfusion injury up to an AST of 5,000 U/L, and that an equal proportion of grafts exhibiting severe ischemia reperfusion injury with AST Ͼ5,000 U/L provide longterm function as are lost to primary nonfunction.…”

“…17,18 However, AST levels alone were not found to be predictive of the occurrence of EAD. 16 Rosen et al 18 demonstrated that patient survival is not influenced by ischemia-reperfusion injury up to an AST of 5,000 U/L, and that an equal proportion of grafts exhibiting severe ischemia reperfusion injury with AST Ͼ5,000 U/L provide longterm function as are lost to primary nonfunction. According to Glanemann et al, 19 liver grafts releasing AST levels between 1,000 and 5,000 U/L are not later indications for retransplantation; however, the 9.83-fold increased relative risk for primary nonfunction in these livers shows that these patients still require more attention.…”

“…Each patient received 1 to 6 MARS treatments lasting for a median of 16 (14)(15)(16)(17)(18)(19) hours. The combination of serum bilirubin Ͼ10 mg/dL, PDR ICG Ͻ10% per minute, AST/ALT Ͼ1,000 U/L, and PT Ͻ40% was present in 4 patients.…”

Prognostic model for early acute rejection after liver transplantation

“…These are immunosuppressive regimen, moderate to severe preservation injury (defined as aspartate transaminase level Ͼ600 U/L within the first 72 hours after LT), 22 and abdominal bleeding requiring a new laparotomy within 48 hours after LT.…”