Etiologies and Independent Risk Architecture of 7-Day Graft Loss in Adult Liver Transplantation: A National Registry Analysis.

Abstract

Objectives: Seven -day graft loss (first postoperative week graft failure or recipient death ) has not been systematically characterized at a national scale in adult liver transplantation. We identified etiologies and independent predictors of 7 -day graft loss, primary nonfunction, and 7 -day posttransplant death in adult deceased donor liver transplant recipients.

Materials and methods: We retrospectively analyzed 54 646 adult deceased donor liver transplant recipients (Organ Procurement and Transplantation Network, 2015 -2024 )and evaluated etiologies and independent predictors of 7 -day graft loss, primary nonfunction, and 7 -day posttransplant death using multivariable logistic regression.

Results: Among 1442 events of 7 -day graft loss (2.6 % ), primary nonfunction predominated (43.6 % ), followed by graft thrombosis (10.3 % ) and infection (3.8 % ). Cardiovascular failure (42.6 % ) was the leading cause of 7 -day death. Retransplant (odds ratio 3.72; P < .001 ), Status 1 (odds ratio 2.24; P < .001 ), donation after circulatory death (odds ratio 1.82; P < .001 ), dialysis dependence (odds ratio 1.79; P <.001 ), and Black recipient race (odds ratio 1.74; P < .001 ) independently predicted 7 -day graft loss. Male recipient sex was protective (odds ratio 0.86; P = .01 ). Each additional hour of cold ischemia time increased 7 -day graft loss odds by 10 % (odds ratio 1.10; P < .001 ). The primary nonfunction model identified Hispanic (odds ratio 1.27; P = .03 ) and Asian (odds ratio 1.60; P = .02 ) recipient race as additional predictors, with 34 % lower odds from 2020 onward (odds ratio 0.66; P < .001 ), coincident with acuity circle allocation and expanded machine perfusion adoption. The 7 -day death model added recipient age ≥60 years (odds ratio 1.58; P < .001 ) and elevated Model for End -Stage Liver Disease score (odds ratio 1.01; P = .003 ) as independent contributors.

Conclusions: Every predictor is ascertainable before transplant, supporting risk stratification during organ offers, informed donor -recipient matching, and perioperative optimization to reduce early graft loss.