Wiemann Bengt A, Beetz Oliver, Weigle Clara A, Tessmer Philipp, Störzer Simon, Kleine-Döpke Dennis, Vondran Florian W R, Richter Nicolas, Schmelzle Moritz, Oldhafer Felix
Department of General, Visceral and Transplant Surgery, Hannover Medical School, Carl-Neuberg-Str. 1, D-30625, Hannover, Germany.
Department of General, Visceral, Pediatric and Transplant Surgery, RWTH Aachen University Hospital, Pauwelsstr. 30, D-52074, Aachen, Germany.
Langenbecks Arch Surg. 2025 Feb 19;410(1):76. doi: 10.1007/s00423-025-03633-8.
Early Allograft Dysfunction (EAD) is a serious complication following liver transplantation. With more marginal donors and critical recipients, identifying EAD risk factors and their impact on long-term outcomes is crucial.
We reviewed all liver transplants performed between 2007 and 2017 at our institution, excluding pediatric recipients, combined thoracic transplants, and retransplants in the same hospital stay. EAD was defined as either: (i) AST/ALT > 2000 IU/l in first 7 postoperative days (POD), (ii) Bilirubin ≥ 10 mg/dl on POD 7, (iii) INR ≥ 1.6 on POD 7.
Of the 621 cases analyzed, the EAD rate was 53.6%. Multivariate analysis identified only donor-dependent variables as independent risk factors for the onset of EAD: donor age (p = 0.012), donor serum sodium (p = 0.021), cold ischemic time (p = 0.007) and graft weight (p < 0.001). EAD significantly impaired graft survival (69.2% vs. 86.2% after 1 year; p = 0.005) but did not impact long-term patient survival (76.3% vs. 87.6% after 1 year; p = 0.162). Of the EAD components, elevated INR proved to be the only reliable predictor of patient mortality. Additionally, an AST/ALT concentration of > 4000 IU/l significantly improved the predictive value of the EAD definition for patient survival (p = 0.002).
EAD risk factors are primarily donor-based and significantly impair graft but not patient survival. The high EAD rates and increased use of marginal grafts suggest the need to adjust conventional EAD definitions to optimize graft allocation in the future.
早期移植肝功能障碍（EAD）是肝移植术后的一种严重并发症。随着更多边缘供体和危重症受体的出现，识别EAD危险因素及其对长期预后的影响至关重要。
我们回顾了2007年至2017年在我院进行的所有肝移植手术，排除儿科受体、同期胸部联合移植以及同一住院期间的再次移植。EAD定义为以下情况之一：（i）术后第1个7天内天冬氨酸转氨酶/丙氨酸转氨酶（AST/ALT）>2000 IU/L，（ii）术后第7天胆红素≥10 mg/dl，（iii）术后第7天国际标准化比值（INR）≥1.6。
在分析的621例病例中，EAD发生率为53.6%。多变量分析仅确定供体相关变量为EAD发生的独立危险因素：供体年龄（p = 0.012）、供体血清钠（p = 0.021）、冷缺血时间（p = 0.007）和移植物重量（p < 0.001）。EAD显著损害移植物存活（1年后为69.2%对86.2%；p = 0.005），但不影响患者长期存活（1年后为76.3%对87.6%；p = 0.162）。在EAD各组成部分中，INR升高被证明是患者死亡的唯一可靠预测指标。此外，AST/ALT浓度>4000 IU/L显著提高了EAD定义对患者存活的预测价值（p = 0.002）。
EAD危险因素主要基于供体，显著损害移植物存活但不影响患者存活。高EAD发生率和边缘移植物使用增加表明，未来需要调整传统EAD定义以优化移植物分配。
