Predictive model and risk factors associated with a revised definition of early allograft dysfunction in liver transplant recipients
Predictive model and risk factors associated with a revised definition of early allograft dysfunction in liver transplant recipients
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DOI：
10.1111/ctr.13097
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发表时间：
2017-11-01
影响因子：
2.1
通讯作者：
Loss, George
中科院分区：
文献类型：
--
作者：
Nicolau-Raducu, Ramona;Cohen, Ari J.;Loss, George
简介：早期同种异体移植物功能障碍（EAD）是一种明确的临床综合征，反映了移植后第一周内的整体移植功能。本研究的目的是进一步完善EAD的定义。方法：在这项研究中，1124例患者纳入分析。Logistic回归分析确定与6个月患者和移植物failure.Results相关的肝损伤标志物：递归分割确定了第一周内观察到的ALT/AST > 3000/6000 IU/dL的临界点，对于修订后的EAD模型，术后第7天胆红素10 mg/dL和INR >= 1.6。更新EAD的发生率为15%（164/1124）。多变量分析确定了与EAD相关的8个危险因素：巨脂肪变性%、供体位置、供体体重、无心跳供体、移植器官类型、恶性相关肝细胞癌、再灌注后综合征严重程度和新鲜冷冻血浆输注量。在存在EAD的情况下，移植后肾脏替代治疗和透析依赖的发生率增加。EAD的存在与6个月死亡率（12%vs3%）和6个月移植物衰竭（8%vs1%.Conclusion：与旧的EAD定义相比，需要更高的AST/ALT水平作为临界值。
Introduction: Early allograft dysfunction (EAD) is a well-defined clinical syndrome that reflects overall graft function within the first week after transplant. The aim of this study was to further refine the definition for EAD.Method: In this study, 1124 patients were included for analysis. Logistic regression was performed to identify markers of liver injury associated with 6-month patient and graft failure.Results: Recursive partitioning identified cut-points for ALT/AST > 3000/6000 IU/dL observed within first week, with bilirubin 10 mg/dL and INR >= 1.6 on postoperative day 7 for the revised EAD model. The incidence of updated EAD was 15% (164/1124). Multivariable analysis identified eight risk factors associated with EAD: % macrosteatosis, donor location, donor weight, nonheart beating donors, type of organ transplanted, recipient-associated hepatocellular carcinoma, severity of postreperfusion syndrome, and the amount of transfused fresh frozen plasma. In the presence of EAD, the incidence of post-transplant renal replacement therapy and dialysis dependence increases. There was a significant association of the presence of EAD with 6-month mortality (12% vs 3%) and 6-month graft failure (8% vs 1%).Conclusion: Higher AST/ALT level needed as cutoff in comparison with the old EAD definition.