Predictive factors of short term outcome after liver transplantation: A review

Abstract

Liver transplantation represents a fundamental therapeutic solution to end-stage liver disease. The need for liver allografts has extended the set of criteria for organ acceptability, increasing the risk of adverse outcomes. Little is known about the early postoperative parameters that can be used as valid predictive indices for early graft function, retransplantation or surgical reintervention, secondary complications, long intensive care unit stay or death. In this review, we present state-of-the-art knowledge regarding the early post-transplantation tests and scores that can be applied during the first postoperative week to predict liver allograft function and patient outcome, thereby guiding the therapeutic and surgical decisions of the medical staff. Post-transplant clinical and biochemical assessment of patients through laboratory tests (platelet count, transaminase and bilirubin levels, INR, factor V, lactates, and Insulin Growth Factor 1) and scores (model for end-stage liver disease, acute physiology and chronic health evaluation, sequential organ failure assessment and model of early allograft function) have been reported to have good performance, but they only allow late evaluation of patient status and graft function, requiring days to be quantified. The indocyanine green plasma disappearance rate has long been used as a liver function assessment technique and has produced interesting, although not univocal, results when performed between the 1^th and the 5^th day after transplantation. The liver maximal function capacity test is a promising method of metabolic liver activity assessment, but its use is limited by economic cost and extrahepatic factors. To date, a consensual definition of early allograft dysfunction and the integration and validation of the above-mentioned techniques, through the development of numerically consistent multicentric prospective randomised trials, are necessary. The medical and surgical management of transplanted patients could be greatly improved by using clinically reliable tools to predict early graft function.

Keywords: Liver transplant, Liver failure, Early allograft dysfunction, Primary non-function, Initial poor function, Outcome predictors, Post operative, Scoring system, Indocyanine green, Liver maximal functional capacity

Core tip: The shortage of available livers and long waiting lists have led to increased transplantation of marginal organs. The model for end-stage liver disease allocation system distributes transplants to sicker patients, potentially impairing the final outcome. A serious pitfall is the lack of early postoperative tools to predict short-term outcome for grafts and patients after liver transplant. Here, we review the currently available functional tests and clinical scores that assess graft and patient status during the first week after liver transplantation to quickly guide the early postoperative surgical and intensive care management.