EARLY ALLOGRAFT DYSFUNCTION AFTER LIVER-TRANSPLANTATION - A DEFINITION AND PREDICTORS OF OUTCOME

Background. Poor graft function early after liver transplantation is a n important cause of morbidity and mortality. We defined early allogra ft dysfunction (EAD) using readily available indices of function and i dentified donor, graft, and pretransplant recipient factors associated with this outcome. Methods. This study examined 710 adult recipients of a first, single-organ liver transplantation for nonfulminant liver disease at three United States centers. EAD was defined by the presenc e of at least one of the following between 2 and 7 days after liver tr ansplantation: serum bilirubin >10 mg/dl, prothrombin time (PT) greate r than or equal to 17 sec, and hepatic encephalopathy. Results. EAD in cidence was 23%. Median intensive care unit (ICU) and hospital stays w ere longer for recipients with EAD than those without (4 days vs. 3 da ys, P=0.0001; 24 vs. 15 days, P=0.0001, respectively). Three-year reci pient and graft survival were worse in those with EAD than in those wi thout (68% vs. 83%, P=0.0001; 61% vs. 79%, P=0.0001). A logistic regre ssion model combining donor, graft, and recipient factors predicted EA D better than models examining these factors in isolation. Pretranspla nt recipient elevations in PT and bilirubin, awaiting a graft in hospi tal or ICU, donor age greater than or equal to 50 years, donor hospita l stay >3 days, preprocurement acidosis, and cold ischemia time greate r than or equal to 15 hr were independently associated with EAD, Concl usion. Recipients who develop EAD have longer ICU and hospital stays a nd greater mortality than those without. Donor, graft, and recipient r isk factors all contribute to the development of EAD. Results of these analyses identify factors that, if modified, may alter the risk of EA D.