Early Allograft Dysfunction after liver transplantation- definition, incidence and relevance in a single-centre analysis.

Purpose: Early Allograft Dysfunction (EAD) is a serious complication following liver transplantation. With more marginal donors and critical recipients, identifying EAD risk factors and their impact on long-term outcomes is crucial.

Methods: We reviewed all liver transplants performed between 2007 and 2017 at our institution, excluding pediatric recipients, combined thoracic transplants, and retransplants in the same hospital stay. EAD was defined as either: (i) AST/ALT > 2000 IU/l in first 7 postoperative days (POD), (ii) Bilirubin ≥ 10 mg/dl on POD 7, (iii) INR ≥ 1.6 on POD 7.

Results: Of the 621 cases analyzed, the EAD rate was 53.6%. Multivariate analysis identified only donor-dependent variables as independent risk factors for the onset of EAD: donor age (p = 0.012), donor serum sodium (p = 0.021), cold ischemic time (p = 0.007) and graft weight (p < 0.001). EAD significantly impaired graft survival (69.2% vs. 86.2% after 1 year; p = 0.005) but did not impact long-term patient survival (76.3% vs. 87.6% after 1 year; p = 0.162). Of the EAD components, elevated INR proved to be the only reliable predictor of patient mortality. Additionally, an AST/ALT concentration of > 4000 IU/l significantly improved the predictive value of the EAD definition for patient survival (p = 0.002).

Conclusions: EAD risk factors are primarily donor-based and significantly impair graft but not patient survival. The high EAD rates and increased use of marginal grafts suggest the need to adjust conventional EAD definitions to optimize graft allocation in the future.