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Background <p>Early allograft dysfunction (EAD) is associated with graft loss up to 5-years after liver transplantation (LT), but longer follow-up data are not available. We investigated which laboratory tests used in the diagnosis of EAD were most strongly associated with long-term LT outcome.</p> Methods <p>We enrolled 101 consecutive HCV-negative adult patients, who underwent their first non-urgent LT between 2001 and 2011. Demographic and clinical data, including graft steatosis on pre-ischemia protocol biopsy, were collected for both recipient and donor.</p> Results <p>The median follow-up was 13.7 years. Among the laboratory tests used for the diagnosis of EAD, graft loss was more strongly associated with serum aminotransferase on the first two postoperative days (POD) than with INR and total bilirubin on POD7. In multivariate Cox analysis, graft loss was associated with a new index of immediate hepatocellular damage (IHD), calculated as the sum of AST and ALT on POD1 and POD2 (HR = 3.27, CI: 1.51–7.08, <i>p</i> = 0.0001), outperforming EAD (HR = 2.27, CI: 1.11–4.62, <i>p</i> = 0.020). Risk factors for IHD were older transplant era, recipient obesity, and graft large droplet steatosis (15%).</p> Conclusions <p>IHD is a strong predictor of long-term graft loss after LT and outperform traditional EAD criteria. Steatotic grafts should increasingly be subjected to defatting methods, and their use should be limited in obese recipients.</p>

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The severity of immediate hepatocellular damage in the first two days after liver transplantation predicts long-term graft survival

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年8月5日

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  • Flaminia Ferri,
  • Simona Parisse,
  • Quirino Lai,
  • Fabio Melandro,
  • Gianluca Mennini,
  • Alessandro Corsi,
  • Mara Riminucci,
  • Francesco Pugliese,
  • Manuela Merli,
  • Massimo Rossi,
  • Stefano Ginanni Corradini

摘要

Background

Early allograft dysfunction (EAD) is associated with graft loss up to 5-years after liver transplantation (LT), but longer follow-up data are not available. We investigated which laboratory tests used in the diagnosis of EAD were most strongly associated with long-term LT outcome.

Methods

We enrolled 101 consecutive HCV-negative adult patients, who underwent their first non-urgent LT between 2001 and 2011. Demographic and clinical data, including graft steatosis on pre-ischemia protocol biopsy, were collected for both recipient and donor.

Results

The median follow-up was 13.7 years. Among the laboratory tests used for the diagnosis of EAD, graft loss was more strongly associated with serum aminotransferase on the first two postoperative days (POD) than with INR and total bilirubin on POD7. In multivariate Cox analysis, graft loss was associated with a new index of immediate hepatocellular damage (IHD), calculated as the sum of AST and ALT on POD1 and POD2 (HR = 3.27, CI: 1.51–7.08, p = 0.0001), outperforming EAD (HR = 2.27, CI: 1.11–4.62, p = 0.020). Risk factors for IHD were older transplant era, recipient obesity, and graft large droplet steatosis (15%).

Conclusions

IHD is a strong predictor of long-term graft loss after LT and outperform traditional EAD criteria. Steatotic grafts should increasingly be subjected to defatting methods, and their use should be limited in obese recipients.