Gruttadauria S, Francesco FD, Vizzini GB, Luca A, Spada M, Cintorino D, Petri SL, Pietrosi G, Pagano D, Gridelli B. Early graft dysfunction following adult-to-adult living-related liver transplantation: Predictive factors and outcomes. World J Gastroenterol 2009; 15(36): 4556-4560 [PMID: 19777614 DOI: 10.3748/wjg.15.4556]
Corresponding Author of This Article
Salvatore Gruttadauria, MD, Associate Professor of Surgery, 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
Article-Type of This Article
Brief Articles
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Gastroenterol. Sep 28, 2009; 15(36): 4556-4560 Published online Sep 28, 2009. doi: 10.3748/wjg.15.4556
Early graft dysfunction following adult-to-adult living-related liver transplantation: Predictive factors and outcomes
Salvatore Gruttadauria, Fabrizio di Francesco, Giovanni Battista Vizzini, Angelo Luca, Marco Spada, Davide Cintorino, Sergio Li Petri, Giada Pietrosi, Duilio Pagano, Bruno Gridelli
Salvatore Gruttadauria, Fabrizio di Francesco, Giovanni Battista Vizzini, Angelo Luca, Marco Spada, Davide Cintorino, Sergio Li Petri, Giada Pietrosi, Duilio Pagano, Bruno Gridelli, 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
Salvatore Gruttadauria, Bruno Gridelli, Thomas Starzl Transplantation Institute, University of Pittsburgh Medical Center, Pittsburgh, 15213 PA, United States
Author contributions: Gruttadauria S and Gridelli B designed the study; Gruttadauria S and di Francesco F contributed equally to writing of the paper; Spada M, Vizzini GB and Luca A analyzed data; Cintorino D, Pagano D, Li Petri S and Pietrosi G collected data.
Correspondence to: Salvatore Gruttadauria, MD, Associate Professor of Surgery, 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
Telephone: +39-91-2192111 Fax: +39-91-2192400
Received: June 28, 2009 Revised: August 13, 2009 Accepted: August 20, 2009 Published online: September 28, 2009
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.
