Hepatic flow is an intraoperative predictor of early allograft dysfunction in whole-graft deceased donor liver transplantation: An observational cohort study

Table 1 Demographic baseline characteristics

Baseline characteristics
Age (yr)	51.45 (9.92)
Gender (male/female)	152/43
Weight (kg)	76.39 (13.71)
Height (cm)	168.74 (7.77)
MELD score (points)1	15.3 (6.82)
Aetiology of liver diseases [number (%)]
Viral cirrhosis	65 (33.3)
Hepatocellular carcinoma	95 (41.7)
Alcoholic cirrhosis	51 (26.2)
Fulminant hepatic failure	3 (1.3)
Primary biliary cirrhosis	5 (2.2)
Acute retransplantation	5 (2.2)
Chronic rejection	1 (0.4)
Sclerosing cholangitis	6 (2.6)
Cryptogenic cirrhosis	11 (4.8)
Hemochromatosis	1 (0.4)

¹The MELD score does not take into account extra exception points. MELD: Model of end liver disease.

Table 2 Univariate and multivariate analysis for the development of early allograft dysfunction

Variables	Univariate analysis			Multivariate logistic regression
	EAD (n = 54)	Non-EAD (n = 141)	P value	β	Relative risk (95%CI)	P value
Donor
Age	62.30 ± 15.67	58.17 ± 18.10	0.21
Donor AST (IU/L)	50.77 ± 56.65	43.44 ± 43.88	0.71
Donor ALT (IU/L)	48.64 ± 53.36	38.97 ± 51.51	0.04
Donor GGT (IU/L)	70.67 ± 111.53	60.63 ± 116.96	0.59
Epinephrine dose (mg/kg/min)	0.27 ± 0.32	0.30 ± 0.36	0.78
Na levels in donor blood	147.13 ± 8.52	146.94 ± 8.47	0.99
DRI	1.61 ± 0.29	1.57 ± 0.32	0.46
ICU time (d)	4.13 ± 4.83	3.17 ± 3.75	0.64
Recipient
Age	52.11 ± 9.21	51.89 ± 10.21	0.88
MELD	15.11 ± 6.86	15.37 ± 6.83	0.73
MELD-Na	17.49 ± 7.57	17.71 ± 7.66	0.99
Creatinine (mg/dL)	0.91 ± 0.48	1.08 ± 1.09	0.26
GOT basal (IU/L)	426.88 ± 1168.84	164.58 ± 435.5	0.52
Bilirubin basal (mg/dL)	7.21 ± 8.74	6.23 ± 8.14	0.74
INR basal	1.61 ± 0.69	1.58 ± 1.06	0.53
Preservation
Cold ischaemia time (min)	525.74 ± 153.03	464.94 ± 142.52	0.01
Hot ischaemia time (min)	57.26 ± 21.08	54.57 ± 22.4	0.20
Total ischaemia time (min)	584.17 ± 154.18	520.53 ± 139.1	0.01
Intraoperative
Intraoperative red blood cells (units)	3.00 ± 2.54	3.08 ± 3.18	0.73
Intraoperative platelets (units)	2.00 ± 2.69	2.56 ± 3.76	0.83
Intraoperative plasma (units)	0.91 ± 1.72	0.75 ± 1.74	0.53
Intraoperative cryoprecipitate (g)	1.59 ± 1.57	1.44 ± 1.86	0.22
Hepatic arterial flow (mL/min)	227.74 ± 134.13	279.67 ± 152,8	0.01
Portal venous flow (mL/min)	1363.84 ± 602.06	1606.7 ± 491.5	0.01
Hepatic total flow (mL/min)	1591.81 ± 631.07	1883.2 ± 513.1	0.01
HAF < 180 mL/min				2.41	(1.18-4.89)	0.02
PVF < 1200 mL/min				2.89	(1.45-5.73)	0.01
TIT > 610 min				2.31	(1.15-4.65)	0.02

DRI: Donor risk index; HAF: Hepatic artery flow; ICU: Intensive care unit; INR: International normalized ratio; MELD: Model of end liver disease; PVF: Portal vein flow; THF: Total hepatic flow.

Table 3 Univariate and multivariate Cox regression models of mortality at 30 d

Variables	Univariate Cox regression			Multivariate Cox regression
	β	Relative risk (95%CI)	P value	β	Relative risk (95%CI)	P value
Donor
Age	1.03	(0.97-1.08)	0.28
Donor AST (IU/L)	1	(0.99-1.02)	0.84
Donor ALT (IU/L)	0.99	(0.97–1.02)	0.63
Donor GGT (IU/L)	1	(0.99–1.01)	0.93
Epinephrine dose (mg/kg/min)	0.03	(0.00–5.69)	0.93
Na levels in donor blood	0.93	(0.84–1.03)	0.19
DRI	4.49	(0.26–76.92)	0.3
ICU time (d)	1.04	(0.89–1.22)	0.62
Recipient
Age	1.04	(0.94-1,14)	0.43
MELD	0.88	(0.72–1.08)	0.22
MELD-Na	0.98	(0.87–1.11)	0.76
Creatinine (mg/dL)	1.08	(0.52–2.26)	0.83
AST basal (IU/L)	1	(1-1)	0.03
Bilirubin basal (mg/dL)	0.98	(0.88–1.09)	0.75
INR basal	1.03	(0.44–2.39)	0.95
Preservation
Cold ischaemia time (min)	1	(0.99–1.00)	0.31
Hot ischaemia time (min)	1	(0.98–1.04)	0.56
Total ischaemia time (min)	1	(0.99-1)	0.33
Intraoperative
Need red blood cells (units)	1.17	(0.91–1.50)	0.37
Need intraoperative platelets (units)	0.92	(0.70–1.20)	0.54
Need intraoperative plasma (units)	0.93	(0.60–1.43)	0.74
Need intraoperative cryoprecipitate (g)	1.1	(0.71–1.70)	0.68
Hepatic arterial flow (mL/min)	0.99	(0.97-1)	0.01
Portal venous flow (mL/min)	0.99	(0.99–1.00)	0.01
Total hepatic flow (mL/min)	0.99	(0.98–1.00)	0.04
HAF < 180 mL/min	5.9	(1.13–30.99)	0.04	5.33	(1.01–28.22)	0.04
PVF < 1200 mL/min	5.31	(1.02–27.70)	0.04
INR day 1 > 2,2	6.07	(1.11–33.22)	0.04
AST day 1 > 2000 UI/dL	10.82	(1.26–92.97)	0.03	9.856	(1.15–84.78)	0.04

DRI: Donor risk index; HAF: Hepatic artery flow; ICU: Intensive care unit; INR: International normalized ratio; MELD: Model of end liver disease; PVF: Portal vein flow; THF: Total hepatic flow.