New paper from A2ALL investigates risk factors for early allograft dysfunction

After living donor liver transplantation, a recipient may experience complications with the transplanted organ soon after surgery. Early Allograft Dysfunction (EAD) may occur when the liver is too small to meet recipient needs, although factors other than size can contribute to EAD. Recent acceptable results with smaller left lobe grafts suggest that the effects of graft size could be mitigated with careful patient selection and technical innovation, such as inflow modification. This has led to renewed interest in smaller grafts to reduce risk to donors during surgery without compromising recipient outcomes.

In a paper published in Transplantation, investigators sought to characterize EAD after living donor liver transplantation and to develop models to predict the risk of dysfunction. Using data from the Adult to Adult Living Donor Liver Transplantation Cohort Study (A2ALL), they found several risk factors associated with EAD, including: left lobe grafts, lower graft weight among left lobes, higher preoperative bilirubin, higher portal reperfusion pressure, higher donor age, and higher donor body mass index (BMI).

Patients who developed EAD after living donor liver transplantation had a 24% risk of graft loss within 90 days. Among those without EAD, the risk of graft loss was only 5%. Although EAD was associated with a higher risk of early graft failure, this relationship was true for recipients of larger as well as smaller graft size.

According to investigator James Pomposelli, MD, PhD, “With regard to mitigating risk of post-surgery complications, the findings in our paper may help transplant surgeons with several preoperative and intraoperative factors, including suitability of the recipient for living donor transplantation.” 
The findings also confirmed published observations that a complex interplay of factors, not just graft size, contribute to the development of allograft dysfunction. Investigators hope that further study will lead to a specific “EAD risk index” that will help clinicians determine graft prognosis and manage the first 90 days after transplant surgery.

CITATION:Pomposelli JJ, Goodrich NP, Emond JC, Humar A, Baker TB, Grant DR, Fisher RA, Roberts JP, Olthoff KM, Gillespie BW, Merion RM. Patterns of early allograft dysfunction in adult live donor liver transplantation: The A2ALL experience. Transplantation 2016;100(7):1490-1499.
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