Predictive factors of short term outcome after liver transplantation: A review

Table 1 Recent definitions of initial poor function and primary non function

Ref.	IPF	PNF
Broering et al[107]	ALT or AST or GDH > 2000 IU/L	Not-life sustaining graft leading to retransplantation or death within POD10
	FFP substituted for > 5 d postoperatively
Nanashima et al[108]	Two consecutive measurements within POD3:	IPF-induced retransplantation or death
	ALT or AST > 1500 IU/L
Heise et al[109]	Scoring system based on ALT, AST, bile output, Prothrombin activity on POD1-3-7-14 (Berlin score ranging from 4 to 8) Berlin C (IPF): 7-8
Tekin et al[110]	On POD7: AST > 1500 IU/L and PT > 20 s	Not-life sustaining graft leading to retransplantation or death within POD7
Ben-Ari et al[111]	AST or ALT > 2000 IU/L on POD2	Not-life sustaining graft leading to retransplantationor death within POD10
	INR > 1.6 on POD2-10
	Bilirubin > 10 mg/dL on POD2-10
Kremers et al[112]		ALT > 2500 IU/L
		Glucose < 60 mg/dL
		INR > 2.5
		bile flow < 50 mL/d
Pokorny et al[113]	On POD5: AST > 2500 IU/L or clotting support > 2 d	Not-life sustaining graft leading to retransplantationor death within POD7
Monbaliu et al[114]		Persisting encephalopathy
		Irreversible metabolic acidosis
		Profound hypoglicaemia
		Severe coagulopathy
		Insufficient bile production
		Increased AST
Cieślak et al[115]	Within POD1-7
	AST or ALT > 2500 IU/L or Prothrombin index < 50%
Dhillon et al[116]	[(AST+ALT)/2] on POD2:	IPF-induced retransplantationor death within POD7
	< 285 IU/L: good function
	285-986 IU/L: average function
	> 986 IU/L: IPF
Nemes et al[117]	On POD5: [Serum bilirubin (μmol/L)]/[Prothrombin (%)] > 1
Olthoff et al[81]	On POD1-7, one within:
	Bilirubin ≥ 10 mg/dL on POD7
	INR ≥ 1.6 on POD7
	ALT or AST > 2000 IU/L within POD7
Stockmann et al[59] and Lock et al[60]	Two LiMax readouts during the first 24 h: LiMax = 60-120 μg/kg per hour	Two LiMax readouts during the first 24 h: LiMax < 60 μg/kg per hour
Máthé et al[118]	Two consecutive measurements within POD3: ALT or AST > 1500 IU/L	IPF-induced retransplantation or death

Table freely extracted from Olthoff et al[81], Chen et al[12] and Pareja et al[106]. The mentioned studies are cited in chronological order. ALT: Alanine - aminotransferase; AST: Aspartate - aminotransferase; FFP: Fresh free plasma; GDH: Glutamate dehydrogenase; INR: International normalised ratio; LiMax: Liver maximal function Capacity; POD: Postoperative day; PT: Prothrombin time.

Table 2 Overview of the studies applying the mentioned techniques specifically about liver transplant

Technique	Study	Type (P/R)	Primary end-point:	Sample	POD	Cut-off value	AUROC (95%CI)	Sensitivity (%)	Specificity (%)	PPV (%)	NPV (%)
ICG-PDR	Olmedilla et al[35]	P	EAD prediction	172 LT: 31.9% HCC, 29.6% viral, 23.8% alcoholic	1	10%/min	0.967 (0.915-0991)	100 (69-100)	90.4 (84.7-94.6)	40.00	100.00
	Levesque et al[42]	P	EAD prediction	72 LT (including LDLT)	0-5	12.85%/min		90.0	97.0
	Schneider et al[43]	P	Graft loss or patient death on POD30	86 LT: 36% viral, 29% alcoholic	7	12.3%/min	0.729 (0.608-0.850)	69.0	67.0	57.00	77.00
Preoperative MELD + postoperative ICG-PDR	Klinzing et al[45]	P	ICU-LOS, mortality	50 LT	0 (< 6 h after ICU admission)	MELD > 25,	0.79	100.0	59.0
						ICG-PDR < 20%/min
ICG-PDR + INR	Olmedilla et al[44]	P	1-mo mortality or need for retransplantation within POD7	332 LT (+77 validations)	1	ICG-PDR < 10%/min,	0.76 (0.66-0.86)	48 (31-66)	95 (91-97)	50 (32-68)	94 (91-96)
						INR > 2.2
LiMax	Lock et al[58]	P	EAD requiring reintervention before POD2 or causing death/retransplantation within POD14	99 LT: 32% alcoholic, 23% HCV	0	64 μg/kg per hour	0.960 (0.921-0.998)	100 (60-100)	92 (84-97)	53 (27-78)	100 (95-100)
					1	43 μg/kg per hour	0.992 (0.975-1.000)	100 (31-100)	100 (94-100)	100 (31-100)	100 (94-100)
Platelets count	Lesurtel et al[72]	R	Severe complications or 3-mo mortality	257 LT: 38% HCV	5	60 × 109/L		58.0	61.0
	Li et al[70]	R	EAD prediction	234 LDLT: 45% HCC	2	68 × 109/L	0.678	73.0	59.0
Factor V	Zulian et al[76]	R	Graft failure within POD90	105 LT: 79.5% HCC, 76.2% HCV	2	41.50%	0.650	42.9	87.9	35.30	90.90
AST	Robertson et al[78]	P	Graft loss at POD90	1091 LT: 22% HCV	3	2 cut-offs: 106.5 IU and 2744.5 IU	0.739 (0.663-0.814)			34.62	99.45
Bilirubin	Wagener et al[80]	R	Graft loss or death within POD90	572 LT: 51.9% HCV	2	6.55 mg/dL	0.809 (0.742-0.877)	72.5	70.4
Bilirubin, INR and transaminases	Olthoff et al[81]	R	EAD definition to predict mortality and graft loss	300 LT	7	Bilirubin > 10 mg/dL, INR > 1.6, ALT or AST > 2000 IU/mL	0.75-0.78
Lactates	Wu et al[84]	P	EAD prediction	222 LT: 50% HBV, 41% HCC	1	24.80%	0.961 (0.948-0.974)	95.5	88.9
IGF-1	Bassanello et al[88]	P	Explore GH/IGF-1 axis changes during the perioperative course of LT	15 LT: 52% viral, 20% alcoholic	7	n.a
	Salso et al[90]	R	90-d patient survival	30 LT: 40% HCV, 20% HBV	15	90 mUI/mL	0.920	86.0	87.0
	Nicolini et al[89]	P	3-yr actual survival	31 LT: 42.5% HCV	15	Normal values classified according to Immunolite 2000® system reference-ranges
MELD	Wagener et al[80]	R	Graft loss or mortality within POD90	572 LT: 51.9% HCV	5	≥ 19	0.812 (0.739-0.886)
	Toshima et al[91]	R	Graft loss or mortality within POD180	217 LDLT: 47.9% HCV	2	≥ 19	0.779	68.2	79.5	27.3	95.7
					7		0.933	100.0	74.9	31.0	100.0
MELD lactate	Cardoso et al[92]	P	Mortality within POD30	58 LT: 43% HCV, 26% alcoholic	1 h after surgery	26.3	0.800
APACHE IV	Hu et al[119]	R	Mortality	195 LT	1	≥ 55.5	0.937 (0.892-0.981)	85.2	91.1	60.5	97.5
SOFA	Wong et al[120]	R	3-mo mortality	149 LT: 53% HBV	7	≥ 8	0.953 (0.902-1.000)	95.0	91.0
CLIF-SOFA	Pan et al[104]	R	1-yr mortality	323 LT: 62% HBV, 27% hepatoma, 26% HCV	3	> 8	0.808 (0.729-0.888)	67.0	87.0
					7		0.877 (0.813-0.941)	64.0	95.0
MEAF	Pareja et al[106]	R	EAD definition ti predict 3-mo mortality	874 LT (+200 validation)	3	> 8

Sample: Only specified if a disease accounts for more than 20% of the overall sample. Where more than one study was present for a specific technique, chronological order has been adopted. Type P: Prospective; Type R: Retrospective; POD: Postoperative day in which best discriminating values were detected; PPV: Positive predictive value; NPV: Negative predictive value; LT: Liver transplant; LDLT: Living donor liver transplant; HCV: Hepatitis C virus; HBV: Hepatitis B virus; HCC: Hepatocellular carcinoma.