Early Allograft Dysfunction After Live Donor Liver Transplantation: It's Time to Redefine?

Viniyendra Pamecha; Bramhadatta Pattnaik; Piyush K Sinha; Nilesh S Patil; Shridhar V Sasturkar; Nihar Mohapatra; Guresh Kumar; Ashok Choudhury; Shiv K Sarin

doi:10.1016/j.jceh.2021.03.007

Early Allograft Dysfunction After Live Donor Liver Transplantation: It's Time to Redefine?

J Clin Exp Hepatol. 2022 Jan-Feb;12(1):101-109. doi: 10.1016/j.jceh.2021.03.007. Epub 2021 Mar 30.

Authors

Viniyendra Pamecha¹, Bramhadatta Pattnaik¹, Piyush K Sinha¹, Nilesh S Patil¹, Shridhar V Sasturkar¹, Nihar Mohapatra¹, Guresh Kumar², Ashok Choudhury³, Shiv K Sarin³

Affiliations

¹ Department of Liver Transplant and Hepato-Pancreato-Biliary Surgery, Institute of Liver & Biliary Sciences, New Delhi, India.
² Department of Biostatistics, Institute of Liver & Biliary Sciences, New Delhi, India.
³ Department of Hepatology, Institute of Liver & Biliary Sciences, New Delhi, India.

Abstract

Background: An ideal definition of early allograft dysfunction (EAD) after live donor liver transplantation (LDLT) remains elusive. The aim of the present study was to compare the diagnostic accuracies of existing EAD definitions, identify the predictors of early graft loss due to EAD, and formulate a new definition, estimating EAD-related mortality in LDLT recipients.

Methods: Consecutive adult patients undergoing elective LDLT were analyzed. Patients with technical (vascular, biliary) complications and biopsy-proven rejections were excluded.

Results: There were 19 deaths due to EAD of a total of 304 patients. On applying the existing definitions of EAD, we revealed their limitations of being either too broad with low specificity or too restrictive with low sensitivity in patients with LDLT. A new definition of EAD-LDLT (total bilirubin >10 mg/dL, international normalized ratio [INR] > 1.6 and serum urea >100 mg/dL, for five consecutive days after day 7) was derived after doing a multivariate analysis. In receiver operator characteristics analysis, an AUC for EAD-LDLT was 0.86. The calibration and internal cross-validation of the new model confirmed its predictability.

Conclusion: The new model of EAD-LDLT, based on total bilirubin >10 mg/dL, INR >1.6 and serum urea >100 mg/dL, for five consecutive days after day 7, has a better predictive value for mortality due to EAD in LDLT recipients.

Keywords: AUC, area under curve; CIT, cold ischemia time; DDLT, deceased donor liver transplantation; DFH, delayed functional hyperbilirubinemia; EAD, early allograft dysfunction; GRWR, graft-to-recipient weight ratio; HDU, high dependency unit; ICU, intensive care unit; INR, international normalized ratio; IR, ischemia-reperfusion; LDLT, living donor liver transplantation; MELD, model for end-stage liver disease; MHV, middle hepatic vein; PGD, primary graft dysfunction; PNF, primary non-function; POD, postoperative day; PPV, positive predictive value; ROC, receiver operator characteristics; SFSS, small for size syndrome; graft dysfunction; hyperbilirubinemia; international normalized ratio; living donor liver transplantation; urea.