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EARLY ALLOGRAFT DYSFUNCTION DECREASES PATIENT SURVIVAL AFTER LIVER TRANSPLANTATION

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2nd IMIRT Conference, 24-25 April 2014, Poitiers, France

PATIENTS AND METHODS

EARLY ALLOGRAFT DYSFUNCTION DECREASES PATIENT SURVIVAL

AFTER LIVER TRANSPLANTATION

Meurisse N, Fieuws S, Jochmans I, Laleman W; Aerts R, Verslype C, Vansteenbergen W, Nevens F, Pirenne J, Monbaliu D.

Department of Abdominal Transplantation and transplant coordination, Abdominal transplant surgery laboratory (microbiology & immunology Department) University Hospitals Leuven, Belgium

Early Allograft Dysfunction (EAD), the clinical manifestation of Ischemia Reperfusion Injury (IRI), is characterized by a poor graft function immediately after Liver Transplantation (LTx). Because of concerns regarding EAD after LTx, we assessed incidence, risk factors and consequences of EAD on outcomes post-LTx in our center.

INTRODUCTION

CONCLUSION & DISCUSSION

P13

RESULTS

Retrospective review:

• January 2000 to December 2010

• 552 LTx were performed with complete follow-up (12 to 132 months).

(end of follow-up 31/12/2010)

• Exclusion criteria:

- < 18 yo

- Combined transplantations - Split and living donation

Definition of EAD post-LTx (Olthoff) (1):

• Bilirubine > 10 mg/dL on day 7 and/or

• International normalized ratio (INR) > 1.6 on day 7 and/or • AST or ALT > 2000 UI/L within the first 7 days after LTx.

LTx recipients who don’t full fill EAD criteria are defined as immediate functioning (IF) LTx. Primary non function (PNF) is defined as the need for retransplantation within one week post LTx due to a non-life-sustaining liver graft function.

OUTCOMES

OR

(95% CI)

p

Value

Procurement team: locally procured vs.

imported

0,51 (0,31 – 0,84) <0,01

Preservation solution type: UW vs. HTK 0,53 (0,31 – 0,91) 0,02

Cold ischemic time (hrs)

1,17 (1,04 – 1,32) 0,01

Lab MELD score

1,06 (1,01 – 1,12) 0,02

Length of surgery (hrs)

1,23 (1,06 – 1,42) 0,01

IF

N=402

(73%)

EAD

N=150

(27%)

p Value

ICU stay (days)

3 (2 – 6)

6 (3 – 19)

<0,01

Hospital stay (days)

18 (14 – 27)

25 (18 – 44) <0,01

Reference: (1) Olthofff KM, Kulik L, Kaminski M et al. Liver Transpl. 2010; 16: 943-949. Validation of a current definition of early allogrfat dysfunction in liver transplant recipients and analysis of risk factors.

INCIDENCE OF EAD

VARIABLES IDENTIFIED AS INDEPENDENT PREDICTORS TO DEVELOP EAD MULTIVARIABLE LOGISTIC REGRESSION MODEL

PATIENT AND GRAFT SURVIVAL

In our series, EAD incidence is 27%

Independent risk factors of EAD post-LTx in our series are:

• Imported livers

• Cold ischemic time

• Length of surgery

• HTK

• Lab MELD score

Surprisingly, Extended Criteria Donor (ECD) & Donation after

Ciruculatory Death (DCD) were not associated with EAD post-LTx.

EAD is associated with a significant:

• Longer ICU and hospital stays

• Higher risk of patient death

EAD is not an innocent temporary phase. This study highlights

the importance of immediate function post LTx and its impact

on LTx recipient survival.

Strategies to reduce EAD are therefore urgently needed. They

should primarily focus on: improving procurement strategies,

re-questioning HTK preservation, reducing cold ischemia time.

In addition, optimizing preservation techniques (e.g. machine

perfusion) and pharmacological modulation of IRI in recipient

need to be studied.

EAD N=150 27% IF N=402 73% 2000 – 2010 552 LTx IF EAD IF EAD

Note that death of the receptor is a competing risk for retransplantation. As such, this Kaplan-Meier curve represents the expected percentage of patients with a

retransplantion in a hypothetical population of patients who are not at risk of dying.

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