ZhengGui Du1, YongGang Wei1, KeFei Chen1, Xi Chen1, ZhiJun Zhang1, HongYu Li1, Yu Ma1, Bo Li2. 1. Department of Liver Surgery, Liver Transplantation Center, West China Hospital, Sichuan University, Chengdu, China. 2. Department of Liver Surgery, Liver Transplantation Center, West China Hospital, Sichuan University, Chengdu, China. Electronic address: doclibo@gmail.com.
Abstract
BACKGROUND: Because deceased liver donors are scarce, adult-to-adult living donor liver transplantation (LDLT) is considered a suitable alterative. However, LDLT grafts are usually partial, resulting in a higher risk of early graft loss (EGL). The aim of the present study was to identify the risk factors and criteria predicting EGL after LDLT. METHODS: We retrospectively analyzed 178 consecutive adults who underwent LDLT. The recipients were divided into two groups as follows: group I, wherein patients showed graft survival longer than 3 mo after LDLT (n = 164), and group II, wherein graft loss occurred within 3 mo after transplantation (n = 14). RESULTS: Univariate analysis showed various risk factors; however, only the preoperative model for end-stage liver disease score, the presence of obvious pretransplant portal hypertension, and intraoperative blood loss were identified as independent predictors of EGL by multivariate analysis. After LDLT, significant differences were observed between the groups in the fold change in total bilirubin levels over postoperative day (POD) 1 (TBIL-f1) and in the international normalized ratio over POD 1 (INR-f1). The combination of TBIL-f1 and INR-f1 on POD 10 was found to be a strong EGL predictor. Furthermore, a minimum indocyanine green (ICG) clearance rate constant K (m-KICG) <0.100/min after POD 3 was found to be the strongest predictor of EGL (sensitivity, 100%; specificity, 97.2%). CONCLUSIONS: The postoperative m-KICG and combination of TBIL-f1 and INR-f1 on POD 10 were useful predictors of EGL; moreover, m-KICG was superior and is expected to be especially useful for ensuring timely retransplantation.
BACKGROUND: Because deceased liver donors are scarce, adult-to-adult living donor liver transplantation (LDLT) is considered a suitable alterative. However, LDLT grafts are usually partial, resulting in a higher risk of early graft loss (EGL). The aim of the present study was to identify the risk factors and criteria predicting EGL after LDLT. METHODS: We retrospectively analyzed 178 consecutive adults who underwent LDLT. The recipients were divided into two groups as follows: group I, wherein patients showed graft survival longer than 3 mo after LDLT (n = 164), and group II, wherein graft loss occurred within 3 mo after transplantation (n = 14). RESULTS: Univariate analysis showed various risk factors; however, only the preoperative model for end-stage liver disease score, the presence of obvious pretransplant portal hypertension, and intraoperative blood loss were identified as independent predictors of EGL by multivariate analysis. After LDLT, significant differences were observed between the groups in the fold change in total bilirubin levels over postoperative day (POD) 1 (TBIL-f1) and in the international normalized ratio over POD 1 (INR-f1). The combination of TBIL-f1 and INR-f1 on POD 10 was found to be a strong EGL predictor. Furthermore, a minimum indocyanine green (ICG) clearance rate constant K (m-KICG) <0.100/min after POD 3 was found to be the strongest predictor of EGL (sensitivity, 100%; specificity, 97.2%). CONCLUSIONS: The postoperative m-KICG and combination of TBIL-f1 and INR-f1 on POD 10 were useful predictors of EGL; moreover, m-KICG was superior and is expected to be especially useful for ensuring timely retransplantation.
Authors: Bo Dai; Nida El Islem Guissi; Lydia Frenzel Sulyok; Mitchell G Bryski; Yiqing Wang; Dongjin Wang; Sunil Singhal; Huiming Cai Journal: Ann Transl Med Date: 2022-01