Reassessment of Relevance and Predictive Value of Parameters Indicating Early Graft Dysfunction in Liver Transplantation: AST Is a Weak, but Bilirubin and INR Strong Predictors of Mortality
Introduction: Early graft dysfunction (EAD) complicates liver transplantation (LT). The aim of this analysis was to discriminate between the weight of each variable as for its predictive value toward patient and graft survival.Methods: We reviewed all LT performed at the Medical University of Innsbr...
Guardado en:
| Autores principales: | , , , , , , , , , , , , , , |
|---|---|
| Formato: | article |
| Lenguaje: | EN |
| Publicado: |
Frontiers Media S.A.
2021
|
| Materias: | |
| Acceso en línea: | https://doaj.org/article/9951cf5dfd014541982ab06ec7b6aa0a |
| Etiquetas: |
Agregar Etiqueta
Sin Etiquetas, Sea el primero en etiquetar este registro!
|
| id |
oai:doaj.org-article:9951cf5dfd014541982ab06ec7b6aa0a |
|---|---|
| record_format |
dspace |
| spelling |
oai:doaj.org-article:9951cf5dfd014541982ab06ec7b6aa0a2021-11-16T04:43:04ZReassessment of Relevance and Predictive Value of Parameters Indicating Early Graft Dysfunction in Liver Transplantation: AST Is a Weak, but Bilirubin and INR Strong Predictors of Mortality2296-875X10.3389/fsurg.2021.693288https://doaj.org/article/9951cf5dfd014541982ab06ec7b6aa0a2021-11-01T00:00:00Zhttps://www.frontiersin.org/articles/10.3389/fsurg.2021.693288/fullhttps://doaj.org/toc/2296-875XIntroduction: Early graft dysfunction (EAD) complicates liver transplantation (LT). The aim of this analysis was to discriminate between the weight of each variable as for its predictive value toward patient and graft survival.Methods: We reviewed all LT performed at the Medical University of Innsbruck between 2007 and 2018. EAD was recorded when one of the following criteria was present: (i) aspartate aminotransferase (AST) levels >2,000 IU/L within the first 7 days, (ii) bilirubin levels ≥10mg/dL or (iii) international normalized ratio (INR) ≥1.6 on postoperative day 7.Results: Of 616 LT, 30.7% developed EAD. Patient survival did not differ significantly (P = 0.092; log rank-test = 2.87), graft survival was significantly higher in non-EAD patients (P = 0.008; log rank-test = 7.13). Bilirubin and INR on postoperative day 7 were identified as strong mortality predictors (Bilirubin HR = 1.71 [1.34, 2.16]; INR HR = 2.69 [0.51, 14.31]), in contrast to AST (HR = 0.91 [0.75, 1.10]). Similar results were achieved for graft loss estimation. A comparison with the Model for Early Allograft Function (MEAF) and the Liver Graft Assessment Following Transplantation (L-GrAFT) score identified a superior discrimination potential but lower specificity.Conclusion: Contrarily to AST, bilirubin and INR have strong predictive capacity for patient and graft survival. This fits well with the understanding, that bile duct injury and deprivation of synthetic function rather than hepatocyte injury are key factors in LT.Margot FodorAdriana WoerdehoffWolfgang PeterHannah EsserRupert OberhuberChristian MargreiterManuel MaglioneBenno CardiniThomas ReschAnnemarie WeissenbacherRobert SucherHeinz ZollerHerbert TilgDietmar ÖfnerStefan SchneebergerFrontiers Media S.A.articlelivertransplantationearly allograft dysfunctionoutcomereassessmentSurgeryRD1-811ENFrontiers in Surgery, Vol 8 (2021) |
| institution |
DOAJ |
| collection |
DOAJ |
| language |
EN |
| topic |
liver transplantation early allograft dysfunction outcome reassessment Surgery RD1-811 |
| spellingShingle |
liver transplantation early allograft dysfunction outcome reassessment Surgery RD1-811 Margot Fodor Adriana Woerdehoff Wolfgang Peter Hannah Esser Rupert Oberhuber Christian Margreiter Manuel Maglione Benno Cardini Thomas Resch Annemarie Weissenbacher Robert Sucher Heinz Zoller Herbert Tilg Dietmar Öfner Stefan Schneeberger Reassessment of Relevance and Predictive Value of Parameters Indicating Early Graft Dysfunction in Liver Transplantation: AST Is a Weak, but Bilirubin and INR Strong Predictors of Mortality |
| description |
Introduction: Early graft dysfunction (EAD) complicates liver transplantation (LT). The aim of this analysis was to discriminate between the weight of each variable as for its predictive value toward patient and graft survival.Methods: We reviewed all LT performed at the Medical University of Innsbruck between 2007 and 2018. EAD was recorded when one of the following criteria was present: (i) aspartate aminotransferase (AST) levels >2,000 IU/L within the first 7 days, (ii) bilirubin levels ≥10mg/dL or (iii) international normalized ratio (INR) ≥1.6 on postoperative day 7.Results: Of 616 LT, 30.7% developed EAD. Patient survival did not differ significantly (P = 0.092; log rank-test = 2.87), graft survival was significantly higher in non-EAD patients (P = 0.008; log rank-test = 7.13). Bilirubin and INR on postoperative day 7 were identified as strong mortality predictors (Bilirubin HR = 1.71 [1.34, 2.16]; INR HR = 2.69 [0.51, 14.31]), in contrast to AST (HR = 0.91 [0.75, 1.10]). Similar results were achieved for graft loss estimation. A comparison with the Model for Early Allograft Function (MEAF) and the Liver Graft Assessment Following Transplantation (L-GrAFT) score identified a superior discrimination potential but lower specificity.Conclusion: Contrarily to AST, bilirubin and INR have strong predictive capacity for patient and graft survival. This fits well with the understanding, that bile duct injury and deprivation of synthetic function rather than hepatocyte injury are key factors in LT. |
| format |
article |
| author |
Margot Fodor Adriana Woerdehoff Wolfgang Peter Hannah Esser Rupert Oberhuber Christian Margreiter Manuel Maglione Benno Cardini Thomas Resch Annemarie Weissenbacher Robert Sucher Heinz Zoller Herbert Tilg Dietmar Öfner Stefan Schneeberger |
| author_facet |
Margot Fodor Adriana Woerdehoff Wolfgang Peter Hannah Esser Rupert Oberhuber Christian Margreiter Manuel Maglione Benno Cardini Thomas Resch Annemarie Weissenbacher Robert Sucher Heinz Zoller Herbert Tilg Dietmar Öfner Stefan Schneeberger |
| author_sort |
Margot Fodor |
| title |
Reassessment of Relevance and Predictive Value of Parameters Indicating Early Graft Dysfunction in Liver Transplantation: AST Is a Weak, but Bilirubin and INR Strong Predictors of Mortality |
| title_short |
Reassessment of Relevance and Predictive Value of Parameters Indicating Early Graft Dysfunction in Liver Transplantation: AST Is a Weak, but Bilirubin and INR Strong Predictors of Mortality |
| title_full |
Reassessment of Relevance and Predictive Value of Parameters Indicating Early Graft Dysfunction in Liver Transplantation: AST Is a Weak, but Bilirubin and INR Strong Predictors of Mortality |
| title_fullStr |
Reassessment of Relevance and Predictive Value of Parameters Indicating Early Graft Dysfunction in Liver Transplantation: AST Is a Weak, but Bilirubin and INR Strong Predictors of Mortality |
| title_full_unstemmed |
Reassessment of Relevance and Predictive Value of Parameters Indicating Early Graft Dysfunction in Liver Transplantation: AST Is a Weak, but Bilirubin and INR Strong Predictors of Mortality |
| title_sort |
reassessment of relevance and predictive value of parameters indicating early graft dysfunction in liver transplantation: ast is a weak, but bilirubin and inr strong predictors of mortality |
| publisher |
Frontiers Media S.A. |
| publishDate |
2021 |
| url |
https://doaj.org/article/9951cf5dfd014541982ab06ec7b6aa0a |
| work_keys_str_mv |
AT margotfodor reassessmentofrelevanceandpredictivevalueofparametersindicatingearlygraftdysfunctioninlivertransplantationastisaweakbutbilirubinandinrstrongpredictorsofmortality AT adrianawoerdehoff reassessmentofrelevanceandpredictivevalueofparametersindicatingearlygraftdysfunctioninlivertransplantationastisaweakbutbilirubinandinrstrongpredictorsofmortality AT wolfgangpeter reassessmentofrelevanceandpredictivevalueofparametersindicatingearlygraftdysfunctioninlivertransplantationastisaweakbutbilirubinandinrstrongpredictorsofmortality AT hannahesser reassessmentofrelevanceandpredictivevalueofparametersindicatingearlygraftdysfunctioninlivertransplantationastisaweakbutbilirubinandinrstrongpredictorsofmortality AT rupertoberhuber reassessmentofrelevanceandpredictivevalueofparametersindicatingearlygraftdysfunctioninlivertransplantationastisaweakbutbilirubinandinrstrongpredictorsofmortality AT christianmargreiter reassessmentofrelevanceandpredictivevalueofparametersindicatingearlygraftdysfunctioninlivertransplantationastisaweakbutbilirubinandinrstrongpredictorsofmortality AT manuelmaglione reassessmentofrelevanceandpredictivevalueofparametersindicatingearlygraftdysfunctioninlivertransplantationastisaweakbutbilirubinandinrstrongpredictorsofmortality AT bennocardini reassessmentofrelevanceandpredictivevalueofparametersindicatingearlygraftdysfunctioninlivertransplantationastisaweakbutbilirubinandinrstrongpredictorsofmortality AT thomasresch reassessmentofrelevanceandpredictivevalueofparametersindicatingearlygraftdysfunctioninlivertransplantationastisaweakbutbilirubinandinrstrongpredictorsofmortality AT annemarieweissenbacher reassessmentofrelevanceandpredictivevalueofparametersindicatingearlygraftdysfunctioninlivertransplantationastisaweakbutbilirubinandinrstrongpredictorsofmortality AT robertsucher reassessmentofrelevanceandpredictivevalueofparametersindicatingearlygraftdysfunctioninlivertransplantationastisaweakbutbilirubinandinrstrongpredictorsofmortality AT heinzzoller reassessmentofrelevanceandpredictivevalueofparametersindicatingearlygraftdysfunctioninlivertransplantationastisaweakbutbilirubinandinrstrongpredictorsofmortality AT herberttilg reassessmentofrelevanceandpredictivevalueofparametersindicatingearlygraftdysfunctioninlivertransplantationastisaweakbutbilirubinandinrstrongpredictorsofmortality AT dietmarofner reassessmentofrelevanceandpredictivevalueofparametersindicatingearlygraftdysfunctioninlivertransplantationastisaweakbutbilirubinandinrstrongpredictorsofmortality AT stefanschneeberger reassessmentofrelevanceandpredictivevalueofparametersindicatingearlygraftdysfunctioninlivertransplantationastisaweakbutbilirubinandinrstrongpredictorsofmortality |
| _version_ |
1718426741492416512 |