Artikel
Analysis of risk factors for development of Early Allograft Dysfunction (EAD) after liver transplantation: A Single Center Study of 678 patients
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Autoren
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Dieter Paul Hoyer
- Universitätsklinikum Essen, Allgemein-, Visceral- und Transplantationschirurgie, Essen
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Zoltan Mathé
- Universitätsklinikum Essen, Allgemein-, Visceral- und Transplantationschirurgie, Essen
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Jürgen-Walter Treckmann
- Universitätsklinikum Essen, Allgemein-, Visceral- und Transplantationschirurgie, Essen
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Renate Reinhardt
- Universitätsklinikum Essen, Allgemein-, Visceral- und Transplantationschirurgie, Essen
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Anja Gallinat
- Universitätsklinikum Essen, Allgemein-, Visceral- und Transplantationschirurgie, Essen
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Thomas Minor
- Universitätsklinikum Bonn, Sektion Chirurgische Forschung, Bonn
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Fuat Saner
- Universitätsklinikum Essen, Allgemein-, Visceral- und Transplantationschirurgie, Essen
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Georgios C. Sotiropoulos
- Universitätsklinikum Essen, Allgemein-, Visceral- und Transplantationschirurgie, Essen
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Guido Gerken
- Universitätsklinikum Essen, Klinik für Gastroenterologie und Hepatologie, Essen
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Andreas Paul
- Universitätsklinikum Essen, Allgemein-, Visceral- und Transplantationschirurgie, Essen
| Veröffentlicht: | 26. April 2013 |
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Gliederung
Text
Introduction: Introduction:
Organ shortage and the constantly aging donor population lead nowadays to an increasing acceptance of expanded criteria donor (ECD) livers. These livers are more frequently associated with early allograft dysfunction (EAD) and impaired patient and graft survival. The aim of this study was to evaluate possible prognostic donor factors associated with EAD.
Material and methods: Patients and Methods:
Overall, 678 consecutive adult patients (mean age 51.6 years; 409 males) who received a primary liver transplant between 09/2003 and 12/2011 were included in this retrospective analysis. Standard donor data from deceased heart beating donors were correlated with immediate post-op graft function and overall patient and graft survival. EAD was defined according to Olthoff et al. 2010. Univariate and multivariate logistic regression analysis and cox proportional hazard analysis was performed in order to identify prognostic factors of EAD.
Results: Results:
272 (40.1 %) patients developed EAD. 30-day-survival of patients with and without EAD was 69.4 % and 92.1 % (p<0.0001). 12 months patient survival of patients with EAD was 58.0% of patients without EAD 79.3% (p<0.0001). In univariate analysis age (p=0.0092), male sex (p=0.0110), height (p=0.0030), weight (p<0.0001), BMI (p=0.0003), last gGT (p=0.0009), last serum sodium (p=0.0308) of the donor as well as cold ischemia time (p<0.0001) and degree of macrosteatosis (p=0.0018) as determined by frozen section predicted EAD. In multivariate logistic regression analysis only donor male sex (p=0.0293), last gGT (p=0.0013), macrovesicular steatosis (p=0.0087) and cold ischemic time (p=0.0209) remained independent predictors for EAD. Univariate and multivariate cox proportional hazard analysis showed that donor age (p=0.0048), last ALT (p=0.0088), last gGT (0.0463) and non-rescue allocation (p=0.0083) were predictors of poorer survival rates.
Conclusion: Conclusion:
Male sex, last donor gGT, macrovesicular steatosis and cold ischemic time are most relevant factors for development of early graft dysfunction (EAD). Organ acceptance and allocation policy should consider these factors.
