Predictive model and risk factors associated with a revised definition of early allograft dysfunction in liver transplant recipients

Nicolau‐Raducu, Ramona; Cohen, Ari J.; Bokhari, Amjad; Bohórquez, Humberto; Bruce, David S.; Carmody, Ian C.; Bugeaud, Emily; Seal, John; Sonnier, Dennis I.; Nossaman, Bobby D.; Loss, George E.

doi:10.1111/ctr.13097

Cited by 16 publications

(19 citation statements)

References 23 publications

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“…As persistent uncontrolled coagulopathy be an early sign of transplanted graft dysfunction [74], it is not surprising that the requirement for FFP transfusion was higher in the EAD group than in the non-EAD group. Poor liver graft recovery seems to begin with severe ischemia–reperfusion injury, followed by the continuous presence of coagulopathy [75].…”

Section: Discussionmentioning

confidence: 99%

Predictive utility of the C-reactive protein to albumin ratio in early allograft dysfunction in living donor liver transplantation: A retrospective observational cohort study

et al. 2019

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BackgroundThis study was performed to determine the association between the ratio of C-reactive protein to albumin (CRP/ALB) and the risk of early allograft dysfunction (EAD) in patients undergoing living donor liver transplantation (LDLT).Patients and methodsA total of 588 adult patients undergoing LDLT were retrospectively investigated, after 22 were excluded because of signs of overt infection or history of ALB infusion. The study population was classified into high and low CRP/ALB ratio groups according to EAD. All laboratory variables, including CRP and ALB, had been collected on the day before surgery. A percentage value for the CRP/ALB ratio (%) was calculated as CRP/ALB × 100.ResultsAfter LDLT, 83 patients (14.1%) suffered EAD occurrence. A higher CRP/ALB ratio was independently associated with risk of EAD, Model for End-stage Liver Disease score, fresh frozen plasma transfusion, and donor age. Based on a cutoff CRP/ALB ratio (i.e., > 20%), the probability of EAD was significantly (2-fold) higher in the high versus low CRP/ALB group. The predictive utility of CRP/ALB ratio for EAD was greater than those of other inflammatory markers. In addition, patients with a high CRP/ALB ratio had poorer survival than those with a low CRP/ALB ratio during the follow-up period.ConclusionsThe easily calculated CRP/ALB ratio may allow estimation of the risk of EAD after LDLT and can provide additional information that may facilitate the estimation of a patient’s overall condition.

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Section: Discussionmentioning

confidence: 99%

Predictive utility of the C-reactive protein to albumin ratio in early allograft dysfunction in living donor liver transplantation: A retrospective observational cohort study

et al. 2019

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“…As the continuous score validated by single-center, retrospective studies, both MELDPOD5 and MEAF are the formula conversion of several biochemical markers into numerical variables, which might better evaluate the severity of the patient's prognosis after OLT. Several studies have showed that the presence of EAD defined by the Olthoff criteria substantially affects graft and patient outcome (9,18,23). However, it has reported that EAD defined by the Olthoff criteria, which contains ALT and AST as indicators, is controversial in evaluating the prognosis of graft and patient (24).…”

Section: Discussionmentioning

confidence: 99%

“…Furthermore, the liver function of the EAD patients recovers slower, resulting in patients requiring longer intensive care. Correspondingly, hospital stay and ICU time in the EAD patients would increase (21,23,31).…”

Section: Discussionmentioning

confidence: 99%

Prediction of post-transplant graft survival by different definitions of early allograft dysfunction

Luo¹,

He²,

Chen³

et al. 2021

Ann Palliat Med

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Background: The efficacy of early allograft dysfunction (EAD) definitions in predicting post-transplant graft survival in a Chinese population is still unclear.Methods: A total of 607 orthotopic liver transplants (OLT) have been included in the current study. Model accuracy was evaluated using receiver operating characteristic (ROC) analysis. Risk factors for EAD was evaluated using univariable analysis and multivariable logistic regression model. Results:The 3-, 6-, and 12-month patient/graft survival were 91.6%/91.4%, 91.1%/90%, and 87.5%/87.3%, respectively. MELDPOD5 had a superior discrimination of 3-month graft survival (C statistic, 0.83), compared with MEAF (C statistic, 0.77) and Olthoff criteria (C statistic, 0.72). Multivariate analysis of risk factors for EAD defined by MELDPOD5, showed that donor body mass index (P=0.001), donor risk index (P=0.006), intraoperative use of packed red blood cells (P=0.001), hypertension of recipient (P=0.004), and preoperative total bilirubin (P<0.001) were independent risk factors. Conclusions:The results suggest that MLEDPOD5 is a better criterion of EAD for the Chinese population, which might serve as a surrogate end-point for graft survival in clinical study.

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“…Diagnosis of early allograft dysfunction (EAD) was defined according to the updated criteria designed by Nicolau-Raducu et al before (19). To be specific, patients who met the following items simultaneously within the first week after liver transplantation including: (I) ALT >3,000 IU/mL or AST >6,000 IU/mL; (II) total bilirubin (TB) ≥10 mg/dL; (III) international normalized ratio (INR) ≥1.6 was diagnosed as EAD (19). And diagnostic criteria of PNF was defined as non-recoverable liver function necessitating emergency retransplantation within the first 72 hours after LT (20).…”

Section: Definition For Several Concept Of Complicationsmentioning

confidence: 99%

“…And the peak value for AST level in non-steatosis group was about 55% lower than the correspond value in MaS group (2,178 vs. 4,839 U/L, P<0.05). According to criteria(19) defined before, EAD was occurred in 41 patients (accounting for 16.7% of whole patients). Compared to patients in steatosis group, EAD occurrence in non-steatosis group was much lower than steatosis group (10.7% vs. 22.8%, P<0.05).…”

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confidence: 99%

Clear mortality gap caused by graft macrosteatosis in Chinese patients after cadaveric liver transplantation

Liu¹,

Wang²,

Li³

et al. 2020

Hepatobiliary Surg Nutr

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Background: Liver transplantation (LT) is one of the most effective surgical treatment for patients with end-stage liver disease. Steatosis is a contributor for inferior graft quality. But its impact and safety on transplantation was less assessed in Chinese patients.Methods: Graft steatosis and related information involved in recipients, donors and surgical procedures were retrospectively collected from 239 patients.Results: Donor macrosteatosis (MaS) caused about 2.14 and 2.80 folds of increment on patient and graft mortality. Dose-response analysis revealed prominent risk of grafts on overall patient/organ mortality when MaS content exceeded 10% (P<0.05). Noteworthy, deaths were only observed in MaS group when concurrent with extremely higher post-transplant alanine aminotransferase (ALT, 64%). However, microsteatosis (MiS) grafts didn't affect outcomes after LT. In a cohort of Chinese patients, MaS had comprehensive effects on post-transplant outcomes with relatively lower safety threshold at 10%. Mortality gap caused by MaS grafts was observed in patients with severer ischemia reperfusion injury.Conclusions: Our study revealled the graft MaS affected the post-transplant outcomes in lower risk cutoff in Chinese patients. Further study is worthy to validate these results and investigate inner mechanism under the phenomenon.

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Predictive model and risk factors associated with a revised definition of early allograft dysfunction in liver transplant recipients

Abstract: Higher AST/ALT level needed as cutoff in comparison with the old EAD definition.

Cited by 16 publications

References 23 publications

Predictive utility of the C-reactive protein to albumin ratio in early allograft dysfunction in living donor liver transplantation: A retrospective observational cohort study

Predictive utility of the C-reactive protein to albumin ratio in early allograft dysfunction in living donor liver transplantation: A retrospective observational cohort study

Prediction of post-transplant graft survival by different definitions of early allograft dysfunction

Clear mortality gap caused by graft macrosteatosis in Chinese patients after cadaveric liver transplantation

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