Early allograft dysfunction after liver transplantation: An intermediate outcome measure for targeted improvements

David D. Lee, Kristopher P. Croome, Jefree A. Shalev, Kaitlyn R. Musto, Meenu Sharma, Andrew P. Keaveny, C. Burcin Taner

Research output: Contribution to journalArticle

28 Citations (Scopus)

Abstract

Background. The term early allograft dysfunction (EAD) identifies liver transplant (LT) allografts with initial poor function and portends poor allograft and patient survival. Aims of this study are to use EAD as an intermediate outcome measure in a large single center cohort and identify donor, recipient and peri-operative risk factors. Material and methods. In 1950 consecutive primary LT, donor, recipient and peri-operative data were collected. EAD was defined by the presence of one or more of the following: total bilirubin ≥ 10 mg/dL (171 ìmol/L) or, INR ≥ 1.6 on day 7, and ALT/AST > 2, 000 IU/L within the first 7 days. Results. The incidence of EAD was 26.5%. 1-, 3-, and 5-year allograft and patient survival for patients who developed EAD were significantly inferior to those who did not (P < 0.01 at all time points). Multivariate analysis demonstrated associations in the development of EAD with recipient pre-operative ventilator status, donation after cardiac death allografts, donor age, allograft size, degree of steatosis, operative time and intra-operative transfusion requirements (all P < 0.01). Patients with EAD had a significantly longer hospitalization at 20.9 ± 38.9 days (median: 9; range: 4-446) compared with 10.7 ± 13.5 days (median: 7; range: 3-231) in patients with no EAD (P < 0.01). Conclusions. This is the largest single center experience demonstrating incidence of EAD and identifying factors associated with development of EAD. EAD is a useful intermediate outcome measure for allograft and patient survival. Balancing recipient pretransplant conditions, donor risk factors and intra-operative conditions are necessary for avoiding EAD.

Original languageEnglish (US)
Pages (from-to)53-60
Number of pages8
JournalAnnals of Hepatology
Volume15
Issue number1
DOIs
StatePublished - Jan 1 2016

Fingerprint

Liver Transplantation
Allografts
Outcome Assessment (Health Care)
Tissue Donors
Survival
Transplants
International Normalized Ratio
Incidence
Mechanical Ventilators
Operative Time
Bilirubin
Liver Diseases

Keywords

  • Liver transplantation
  • Outcome
  • Survival

ASJC Scopus subject areas

  • Hepatology

Cite this

Lee, D. D., Croome, K. P., Shalev, J. A., Musto, K. R., Sharma, M., Keaveny, A. P., & Taner, C. B. (2016). Early allograft dysfunction after liver transplantation: An intermediate outcome measure for targeted improvements. Annals of Hepatology, 15(1), 53-60. https://doi.org/10.5604/16652681.1184212

Early allograft dysfunction after liver transplantation : An intermediate outcome measure for targeted improvements. / Lee, David D.; Croome, Kristopher P.; Shalev, Jefree A.; Musto, Kaitlyn R.; Sharma, Meenu; Keaveny, Andrew P.; Taner, C. Burcin.

In: Annals of Hepatology, Vol. 15, No. 1, 01.01.2016, p. 53-60.

Research output: Contribution to journalArticle

Lee, DD, Croome, KP, Shalev, JA, Musto, KR, Sharma, M, Keaveny, AP & Taner, CB 2016, 'Early allograft dysfunction after liver transplantation: An intermediate outcome measure for targeted improvements', Annals of Hepatology, vol. 15, no. 1, pp. 53-60. https://doi.org/10.5604/16652681.1184212
Lee, David D. ; Croome, Kristopher P. ; Shalev, Jefree A. ; Musto, Kaitlyn R. ; Sharma, Meenu ; Keaveny, Andrew P. ; Taner, C. Burcin. / Early allograft dysfunction after liver transplantation : An intermediate outcome measure for targeted improvements. In: Annals of Hepatology. 2016 ; Vol. 15, No. 1. pp. 53-60.
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abstract = "Background. The term early allograft dysfunction (EAD) identifies liver transplant (LT) allografts with initial poor function and portends poor allograft and patient survival. Aims of this study are to use EAD as an intermediate outcome measure in a large single center cohort and identify donor, recipient and peri-operative risk factors. Material and methods. In 1950 consecutive primary LT, donor, recipient and peri-operative data were collected. EAD was defined by the presence of one or more of the following: total bilirubin ≥ 10 mg/dL (171 {\`i}mol/L) or, INR ≥ 1.6 on day 7, and ALT/AST > 2, 000 IU/L within the first 7 days. Results. The incidence of EAD was 26.5{\%}. 1-, 3-, and 5-year allograft and patient survival for patients who developed EAD were significantly inferior to those who did not (P < 0.01 at all time points). Multivariate analysis demonstrated associations in the development of EAD with recipient pre-operative ventilator status, donation after cardiac death allografts, donor age, allograft size, degree of steatosis, operative time and intra-operative transfusion requirements (all P < 0.01). Patients with EAD had a significantly longer hospitalization at 20.9 ± 38.9 days (median: 9; range: 4-446) compared with 10.7 ± 13.5 days (median: 7; range: 3-231) in patients with no EAD (P < 0.01). Conclusions. This is the largest single center experience demonstrating incidence of EAD and identifying factors associated with development of EAD. EAD is a useful intermediate outcome measure for allograft and patient survival. Balancing recipient pretransplant conditions, donor risk factors and intra-operative conditions are necessary for avoiding EAD.",
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AU - Croome, Kristopher P.

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AB - Background. The term early allograft dysfunction (EAD) identifies liver transplant (LT) allografts with initial poor function and portends poor allograft and patient survival. Aims of this study are to use EAD as an intermediate outcome measure in a large single center cohort and identify donor, recipient and peri-operative risk factors. Material and methods. In 1950 consecutive primary LT, donor, recipient and peri-operative data were collected. EAD was defined by the presence of one or more of the following: total bilirubin ≥ 10 mg/dL (171 ìmol/L) or, INR ≥ 1.6 on day 7, and ALT/AST > 2, 000 IU/L within the first 7 days. Results. The incidence of EAD was 26.5%. 1-, 3-, and 5-year allograft and patient survival for patients who developed EAD were significantly inferior to those who did not (P < 0.01 at all time points). Multivariate analysis demonstrated associations in the development of EAD with recipient pre-operative ventilator status, donation after cardiac death allografts, donor age, allograft size, degree of steatosis, operative time and intra-operative transfusion requirements (all P < 0.01). Patients with EAD had a significantly longer hospitalization at 20.9 ± 38.9 days (median: 9; range: 4-446) compared with 10.7 ± 13.5 days (median: 7; range: 3-231) in patients with no EAD (P < 0.01). Conclusions. This is the largest single center experience demonstrating incidence of EAD and identifying factors associated with development of EAD. EAD is a useful intermediate outcome measure for allograft and patient survival. Balancing recipient pretransplant conditions, donor risk factors and intra-operative conditions are necessary for avoiding EAD.

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