Lee David D, Croome Kristopher P, Shalev Jefree A, Musto Kaitlyn R, Sharma Meenu, Keaveny Andrew P, Taner C Burcin
Mayo Clinic Collaborative in Transplant Research and Outcomes, Department of Transplant. Mayo Clinic Florida. USA.
Ann Hepatol. 2016 Jan-Feb;15(1):53-60. doi: 10.5604/16652681.1184212.
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.
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 μmol/L) or, INR ≥ 1.6 on day 7, and ALT/AST > 2,000 IU/L within the first 7 days.
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).
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.
早期移植肝功能障碍（EAD）这一术语用于描述肝移植（LT）后初期功能不佳的移植物，并预示着移植物和患者的不良生存结局。本研究的目的是在一个大型单中心队列中，将EAD用作中间结局指标，并确定供体、受体及围手术期的风险因素。
收集了1950例连续的初次肝移植患者的供体、受体及围手术期数据。EAD的定义为出现以下一项或多项情况：总胆红素≥10mg/dL（171μmol/L），或术后第7天国际标准化比值（INR）≥1.6，以及术后前7天内丙氨酸氨基转移酶（ALT）/天冬氨酸氨基转移酶（AST）>2000IU/L。
EAD的发生率为26.5%。发生EAD的患者1年、3年和5年的移植物及患者生存率显著低于未发生EAD的患者（所有时间点P<0.01）。多因素分析显示，EAD的发生与受体术前呼吸机使用状态、心脏死亡后供肝移植、供体年龄、移植物大小、脂肪变性程度、手术时间及术中输血需求相关（所有P<0.01）。与未发生EAD的患者相比，发生EAD的患者住院时间显著延长，分别为20.9±38.9天（中位数：9天；范围：4 - 446天）和10.7±13.5天（中位数：7天；范围：3 - 231天）（P<0.01）。
这是最大规模的单中心研究，证实了EAD的发生率，并确定了与EAD发生相关的因素。EAD是评估移植物和患者生存的有用中间结局指标。平衡受体移植前状况、供体风险因素及术中情况对于避免EAD的发生很有必要。
