Risk factors, surgical complications and graft survival in liver transplant recipients with early allograft dysfunction

Abstract Background Early allograft dysfunction (EAD) is a severe complication after liver transplantation. The associated risk factors and complications have re-gained recent interest. This study investigated risk factors, survival and complications associated with EAD in a large liver transplant center in Latin America. Methods Retrospective, unicenter, cohort, based on data from adult patients undergoing first deceased-donor liver transplant from January 2009 to December 2013. EAD was defined by one or more of the following: (i) bilirubin ≥10 mg/dL on postoperative day 7; (ii) international normalized ratio ≥1.6 on postoperative day 7, and (iii) alanine aminotransferase or aspartate aminotransferase >2000 IU/L within the first seven days after transplant. Results A total of 602 patients were included; of these 34.2% developed EAD. Donor risk factors were male ( P  = 0.007), age between 50 and 59 years ( P  = 0.034), overweight ( P  = 0.028) or grade I obesity ( P  = 0.012), sodium >157 mmol/L ( P  = 0.002) and grade IV ischemia/reperfusion injury ( P  = 0.002). Cold ischemia time ≥10 h ( P  = 0.008) and warm ischemia time ≥40 min ( P  = 0.013) were the surgical factors. Male ( P P  = 0.001) and had higher graft loss rates (37.9% vs. 21.2%, P P  = 0.238). Conclusions EAD risk factors are related to donor, surgical procedure and recipient. Donor risk factors for EAD were male, age between 50 and 59 years, donor overweight or grade I obesity, sodium >157 mmol/L and grade IV ischemia/reperfusion injury. Cold ischemia time ≥10 h and warm ischemia time ≥40 min were the surgical risk factors. Male was the only recipient protective factor. Patients with EAD had higher reoperations and graft loss rates.