Risk factors, surgical complications and graft survival in liver transplant recipients with early allograft dysfunction.
Hepatobiliary Pancreat Dis Int
; 18(5): 423-429, 2019 Oct.
Article
em En
| MEDLINE
| ID: mdl-30853253
ABSTRACT
BACKGROUND:
Early allograft dysfunction (EAD) is a severe complication after liver transplantation. The associated risk factors and complications have re-gained recent interest. This study investigated risk factors, survival and complications associated with EAD in a large liver transplant center in Latin America.METHODS:
Retrospective, unicenter, cohort, based on data from adult patients undergoing first deceased-donor liver transplant from January 2009 to December 2013. EAD was defined by one or more of the following (i) bilirubin ≥10â¯mg/dL on postoperative day 7; (ii) international normalized ratio ≥1.6 on postoperative day 7, and (iii) alanine aminotransferase or aspartate aminotransferase >2000 IU/L within the first seven days after transplant.RESULTS:
A total of 602 patients were included; of these 34.2% developed EAD. Donor risk factors were male (Pâ¯=â¯0.007), age between 50 and 59 years (Pâ¯=â¯0.034), overweight (Pâ¯=â¯0.028) or grade I obesity (Pâ¯=â¯0.012), sodium >157â¯mmol/L (Pâ¯=â¯0.002) and grade IV ischemia/reperfusion injury (Pâ¯=â¯0.002). Cold ischemia time ≥10 h (Pâ¯=â¯0.008) and warm ischemia time ≥40 min (Pâ¯=â¯0.013) were the surgical factors. Male (P <0.001) was the only recipient protective factor. Compared with the non-EAD group, patients with EAD were submitted to more reoperations (24.3% vs. 13.4%, Pâ¯=â¯0.001) and had higher graft loss rates (37.9% vs. 21.2%, P <0.001), with similar patient survival rates (Pâ¯=â¯0.238).CONCLUSIONS:
EAD risk factors are related to donor, surgical procedure and recipient. Donor risk factors for EAD were male, age between 50 and 59 years, donor overweight or grade I obesity, sodium >157â¯mmol/L and grade IV ischemia/reperfusion injury. Cold ischemia time ≥10 h and warm ischemia time ≥40 min were the surgical risk factors. Male was the only recipient protective factor. Patients with EAD had higher reoperations and graft loss rates.Palavras-chave
Texto completo:
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Base de dados:
MEDLINE
Assunto principal:
Complicações Pós-Operatórias
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Transplante de Fígado
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Função Retardada do Enxerto
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Sobrevivência de Enxerto
Tipo de estudo:
Etiology_studies
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Observational_studies
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Risk_factors_studies
Limite:
Adult
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Female
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Humans
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Male
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Middle aged
Idioma:
En
Ano de publicação:
2019
Tipo de documento:
Article