| Title | Early graft dysfunction following adult-to-adult living-related liver transplantation: Predictive factors and outcomes. | | Author(s) | Gruttadauria S, di Francesco F, Vizzini GB, Luca A, Spada M, Cintorino D, Li Petri S, Pietrosi G, Pagano D, Gridelli B | | Institution | Department of Surgery, University of Pittsburgh, Coordinator Abdominal Adult Transplant. ISMETT (Mediterranean Institute for Transplant and Advanced Specialized Therapies, University of Pittsburgh Medical Center in Italy), Via E. Tricomi N. 1, 90127 Palermo, Italy. sgruttadauria@ismett.edu. | | Source | World J Gastroenterol 2009 Sep 28; 15(36):4556-60. | | Abstract | AIM: To describe a condition that we define as early graft dysfunction (EGD) which can be identified preoperatively.
METHODS: Small-for-size graft dysfunction following living-related liver transplantation (LRLT) is characterized by EGD when the graft-to-recipient body weight ratio (GRBWR) is below 0.8%. However, patients transplanted with GRBWR above 0.8% can develop dysfunction of the graft. In 73 recipients of LRLT (GRBWR > 0.8%), we identified 10 patients who developed EGD. The main measures of outcomes analyzed were overall mortality, number of re-transplants and length of stay in days (LOS). Furthermore we analyzed other clinical pre-transplant variables, intra-operative parameters and post transplant data.
RESULTS: A trend in favor of the non-EGD group (3-mo actuarial survival 98% vs 88%, P = 0.09; 3-mo graft mortality 4.7% vs 20%, P = 0.07) was observed as well as shorter LOS (13 d vs 41.5 d; P = 0.001) and smaller requirement of peri-operative Units of Plasma (4 vs 14; P = 0.036). Univariate analysis of pre-transplant variables identified platelet count, serum bilirubin, INR and Meld-Na score as predictors of EGD. In the multivariate analysis transplant Meld-Na score (P = 0.025, OR: 1.175) and pre-transplant platelet count (P = 0.043, OR: 0.956) were independently associated with EGD.
CONCLUSION: EGD can be identified preoperatively and is associated with increased morbidity after LRLT. A prompt recognition of EGD can trigger a timely treatment. | | Language | eng | | Pub Type(s) | Journal Article
| | PubMed ID | 19777614 |
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