Rafael Diaz-Nieto1, Panagis Lykoudis2, Francis Robertson3, Dinesh Sharma4, Kevin Moore3, Massimo Malago4, Brian R Davidson2. 1. HPB and Liver Transplant Unit, Royal Free Hospital, London, United Kingdom; Royal Free Campus, University College London, London, United Kingdom. Electronic address: rafadiaznieto@hotmail.com. 2. HPB and Liver Transplant Unit, Royal Free Hospital, London, United Kingdom; Royal Free Campus, University College London, London, United Kingdom. 3. Royal Free Campus, University College London, London, United Kingdom. 4. HPB and Liver Transplant Unit, Royal Free Hospital, London, United Kingdom.
Abstract
INTRODUCTION AND OBJECTIVES: Graft failure and postoperative mortality are the most serious complications after liver transplantation. The aim of this study is to establish a prognostic scoring system to predict graft and patient survival based on serum transaminases levels that are routinely used during the postoperative period in human cadaveric liver transplants. PATIENTS AND METHODS: Postoperative graft failure and patient mortality after liver transplant were analyzed from a consecutive series of 1299 patients undergoing cadaveric liver transplantation. This was correlated with serum liver function tests and the rate of reduction in transaminase levels over the first postoperative week. A cut-off transaminase level correlating with graft and patient survival was calculated and incorporated into a scoring system. RESULTS: Aspartate-aminotransferase (AST) on postoperative day one showed significant correlation with early graft failure for levels above 723U/dl and early postoperative mortality for levels above 750U/dl. AST reduction rate (day 1 to 3) greater than 1.8 correlated with reduced graft failure and greater than 2 with mortality. Alanine-aminotransferase (ALT) reduction in the first 48h post transplantation also correlated with outcomes. CONCLUSION: A scoring system with these three variables allowed us to classify our patients into three groups of risk for early graft failure and mortality.
INTRODUCTION AND OBJECTIVES:Graft failure and postoperative mortality are the most serious complications after liver transplantation. The aim of this study is to establish a prognostic scoring system to predict graft and patient survival based on serum transaminases levels that are routinely used during the postoperative period in human cadaveric liver transplants. PATIENTS AND METHODS: Postoperative graft failure and patient mortality after liver transplant were analyzed from a consecutive series of 1299 patients undergoing cadaveric liver transplantation. This was correlated with serum liver function tests and the rate of reduction in transaminase levels over the first postoperative week. A cut-off transaminase level correlating with graft and patient survival was calculated and incorporated into a scoring system. RESULTS:Aspartate-aminotransferase (AST) on postoperative day one showed significant correlation with early graft failure for levels above 723U/dl and early postoperative mortality for levels above 750U/dl. AST reduction rate (day 1 to 3) greater than 1.8 correlated with reduced graft failure and greater than 2 with mortality. Alanine-aminotransferase (ALT) reduction in the first 48h post transplantation also correlated with outcomes. CONCLUSION: A scoring system with these three variables allowed us to classify our patients into three groups of risk for early graft failure and mortality.
Authors: Thanh Khiem Nguyen; Hong Son Trinh; Tuan Hiep Luong; Viet Khai Ninh; Gia Anh Pham; Ham Hoi Nguyen; Trung Nghia Bui; Kim Khue Dang; Tuan Hoang; Quang Nghia Nguyen Journal: Ann Med Surg (Lond) Date: 2021-07-31