Department of General, Transplant, and Liver Surgery, Medical University of Warsaw, Warsaw, Poland.
Department of General, Transplant, and Liver Surgery, Medical University of Warsaw, Warsaw, Poland.
Transplant Proc. 2022 May;54(4):1017-1020. doi: 10.1016/j.transproceed.2022.02.019. Epub 2022 Apr 22.
Early allograft dysfunction (EAD) had been established as a useful tool to asses graft and patient survival after liver transplant. We wanted to evaluate effect of EAD components on early graft survival.
This retrospective study included 264 patients with EAD after liver transplant in the period between 2015 and 2019. The patients with retransplants were excluded from analyses. The EAD was determined with Olthoff criteria. The logistic regression model was used for analyses. The 90-day graft survival was set as a primary outcome measure.
The main indications for transplant in the analyzed group were hepatitis C virus infection (53 patients, 20.1%), hepatitis B infection (22, 8.3%), primary sclerosing cholangitis (28, 10.1%), and alcoholic liver disease (62, 23.5%), with a median model for end-stage liver disease score of 13.5 points. The 90-day graft loss occurred in 51 patients (19.3%). Each of the components used in EAD diagnosis was found to be correlated with 90-day graft loss. The bilirubin concentration on day 7 (odds ratio [OR], 3.1; 95% CI, 1.4-6.7; P < .001), international normalized ratio on day 7 (OR, 179; 95% CI, 39-815; P < .001), and the natural logarithm of alanine aminotransferase (OR, 3.1; 95% CI, 1.6-6.4) and aspartate aminotransferase (OR, 1.4; 95% CI, 0.4-4.9) predicted 90-day graft loss.
In patients with EAD, international normalized ratio ≥ 1.6 on day 7 was the strongest predictor of early graft-loss among all EAD components.
早期移植物功能障碍（EAD）已被确立为评估肝移植后移植物和患者存活率的有用工具。我们想要评估 EAD 成分对早期移植物存活率的影响。
本回顾性研究纳入了 2015 年至 2019 年间 264 例肝移植后发生 EAD 的患者。排除再次移植的患者。EAD 采用 Olthoff 标准确定。采用逻辑回归模型进行分析。90 天移植物存活率设为主要观察终点。
分析组的主要移植适应证为丙型肝炎病毒感染（53 例，20.1%）、乙型肝炎感染（22 例，8.3%）、原发性硬化性胆管炎（28 例，10.1%）和酒精性肝病（62 例，23.5%），中位终末期肝病模型评分为 13.5 分。51 例患者（19.3%）发生 90 天移植物丢失。EAD 诊断中使用的每个成分均与 90 天移植物丢失相关。第 7 天胆红素浓度（比值比 [OR]，3.1；95%置信区间 [CI]，1.4-6.7；P<0.001）、第 7 天国际标准化比值（OR，179；95%CI，39-815；P<0.001）、丙氨酸氨基转移酶（OR，3.1；95%CI，1.6-6.4）和天冬氨酸氨基转移酶（OR，1.4；95%CI，0.4-4.9）的自然对数值均预测 90 天移植物丢失。
在 EAD 患者中，第 7 天国际标准化比值≥1.6 是所有 EAD 成分中早期移植物丢失的最强预测因素。
