Intraoperative Risk Factors of Early Allograft Dysfunction at a Liver Transplantation Center in Brazil: A Retrospective Study.

Background: Early allograft dysfunction (EAD) is a serious complication of liver transplantation. Multiple donor, recipient, and intraoperative risk factors contribute to its development. This study aims to assess the impact of intraoperative risk factors for EAD on clinical outcomes of liver transplant recipients.

Methods: This retrospective study enrolled brain-dead donors and adult liver graft recipients. Recipient-donor matching was facilitated via a crossover list, and comprehensive clinical and laboratory data were recorded for donors, recipients, and surgical procedures. The primary outcome assessed was EAD. Secondary outcomes were the association between anatomical variants with bleeding volume and need for blood transfusions, length of ICU and hospital stay, retransplantation, and patient and graft survival after 12 months.

Results: A total of 228 patients underwent liver transplants from brain-dead donors between January 2019 and December 2021. The incidence of EAD was 25%. In the univariate analysis, liver graft steatosis, previous abdominal surgery, biliary reconstruction in Roux-in-Y, total transplantation time, bleeding volume, and the need for all types of blood products were associated with EAD. However, after adjustment for the Model for End Stage Liver Disease (MELD) score, only biliary reconstruction in Roux-in-Y (OR 4.58, 95% CI 1.63-12.83, P = .004) and total transplantation time (OR 1.01, 95% CI 1.003-1.014, P = .0002) persisted in association with EAD. Anatomical variants were not associated with EAD, increased bleeding and the need for blood transfusions or other clinical outcomes.

Conclusions: Biliary reconstruction in Roux-in-Y and total transplantation time were associated with EAD development while anatomical artery variants were not.