Early allograft dysfunction after liver transplantation: A definition and predictors of outcome

Background. Poor graft function early after liver transplantation is an important cause of morbidity and mortality. We defined early allograft dysfunction (EAD) using readily available indices of function and identified donor, graft, and pretransplant recipient factors associated with this outcome. Methods. This study examined 710 adult recipients of a first, single-organ liver transplantation for non-fulminant liver disease at three United States centers. EAD was defined by the presence of at least one of the following between 2 and 7 days after liver transplantation: serum bilirubin >10 mg/dl, prothrombin time (PT) ≤17 sec, and hepatic encephalopathy. Results. EAD incidence was 23%. Median intensive care unit (ICU) and hospital stays were longer for recipients with EAD than those without (4 days vs. 3 days, P=0.0001; 24 vs. 15 days, P=0.0001, respectively). Three-year recipient and graft survival were worse in those with EAD than in those without (68% vs. 83%, P=0.0001; 61% vs. 79%, P=0.0001). A logistic regression model combining donor, graft, and recipient factors predicted EAD better than models examining these factors in isolation. Pretransplant recipient elevations in PT and bilirubin, awaiting a graft in hospital or ICU, donor age ≤50 years, donor hospital stay >3 days, preprocurement acidosis, and cold ischemia time ≤15 hr were independently associated with EAD. Conclusion. Recipients who develop EAD have longer ICU and hospital stays and greater mortality than those without. Donor, graft, and recipient risk factors all contribute to the development of EAD. Resuits of these analyses identify factors that, if modified, may alter the risk of EAD.