Validation of a current definition of early allograft dysfunction in liver transplant recipients and analysis of risk factors

Kim M. Olthoff; Laura Kulik; Benjamin Samstein; Mary Kaminski; Michael Abecassis; Jean Emond; Abraham Shaked; Jason D. Christie

doi:10.1002/lt.22091

journal article Aug 01, 2010

Validation of a current definition of early allograft dysfunction in liver transplant recipients and analysis of risk factors

Kim M. Olthoff

Laura Kulik Benjamin Samstein Mary Kaminski Michael Abecassis Jean Emond Abraham Shaked Jason D. Christie

Liver Transplantation Vol. 16 No. 8 pp. 943-949 · Ovid Technologies (Wolters Kluwer Health)

View at Publisher Save 10.1002/lt.22091

Abstract

Abstract
Translational studies in liver transplantation often require an endpoint of graft function or dysfunction beyond graft loss. Prior definitions of early allograft dysfunction (EAD) vary, and none have been validated in a large multicenter population in the Model for End-Stage Liver Disease (MELD) era. We examined an updated definition of EAD to validate previously used criteria, and correlated this definition with graft and patient outcome. We performed a cohort study of 300 deceased donor liver transplants at 3 U.S. programs. EAD was defined as the presence of one or more of the following previously defined postoperative laboratory analyses reflective of liver injury and function: bilirubin ≥10mg/dL on day 7, international normalized ratio ≥1.6 on day 7, and alanine or aspartate aminotransferases >2000 IU/L within the first 7 days. To assess predictive validity, the EAD definition was tested for association with graft and patient survival. Risk factors for EAD were assessed using multivariable logistic regression. Overall incidence of EAD was 23.2%. Most grafts met the definition with increased bilirubin at day 7 or high levels of aminotransferases. Of recipients meeting the EAD definition, 18.8% died, as opposed to 1.8% of recipients without EAD (relative risk = 10.7 [95% confidence interval: 3.6, 31.9] P < 0.0001). More recipients with EAD lost their grafts (26.1%) than recipients with no EAD (3.5%) (relative risk = 7.4 [95% confidence interval: 3.4, 16.3] P < 0.0001). Donor age and MELD score were significant EAD risk factors in a multivariate model. In summary a simple definition of EAD using objective posttransplant criteria identified a 23% incidence, and was highly associated with graft loss and patient mortality, validating previously published criteria. This definition can be used as an endpoint in translational studies aiming to identify mechanistic pathways leading to a subgroup of liver grafts with clinical expression of suboptimal function. Liver Transpl 16:943-949, 2010. © 2010 AASLD.

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Details

Published: Aug 01, 2010
Vol/Issue: 16(8)
Pages: 943-949
License: View

Authors

Cite This Article

Kim M. Olthoff, Laura Kulik, Benjamin Samstein, et al. (2010). Validation of a current definition of early allograft dysfunction in liver transplant recipients and analysis of risk factors. Liver Transplantation, 16(8), 943-949. https://doi.org/10.1002/lt.22091

Validation of a current definition of early allograft dysfunction in liver transplant recipients and analysis of risk factors

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