Published online Sep 27, 2019. doi: 10.4254/wjh.v11.i9.689
Peer-review started: April 15, 2019
First decision: June 5, 2019
Revised: June 25, 2019
Accepted: September 5, 2019
Article in press: September 5, 2019
Published online: September 27, 2019
Early allograft dysfunction (EAD) after liver transplantation (LT) is an important cause of morbidity and mortality. To ensure adequate graft function, a critical hepatocellular mass is required in addition to an appropriate blood supply. We hypothesized that intraoperative measurement of portal venous and hepatic arterial flow may serve as a predictor in the diagnosis of EAD.
To study whether hepatic flow is an independent predictor of EAD following LT.
This is an observational cohort study in a single institution. Hepatic arterial blood flow and portal venous blood flow were measured intraoperatively by transit flow. EAD was defined using the Olthoff criteria. Univariate and multivariate analyses were used to determine the intraoperative predictors of EAD. Survival analysis and prognostic factor analysis were performed using the Kaplan-Meier and Cox regression models.
A total of 195 liver transplant procedures were performed between January 2008 and December 2014 in 188 patients. A total of 54 (27.7%) patients developed EAD. The median follow-up was 39 mo. Portal venous flow, hepatic arterial flow (HAF) and total hepatic arterial flow were associated with EAD in both the univariate and multivariate analyses. HAF is an independent prognostic factor for 30-d patient mortality.
Intraoperative measurement of blood flow after reperfusion appears to be a predictor of EAD; Moreover, HAF should be considered a predictor of 30-d patient mortality.
Core tip: Early allograft dysfunction (EAD) is a problem that can soon occur after liver implantation. Currently, there are a large number of predictive models for graft failure. In general, the models try to predict the development of liver dysfunction and aid clinicians in the decision-making process of selecting the liver graft. These variables do not need to be modified, so we propose that measurable arterial and venous flow intraoperatively after implantation may be useful in predicting the development of EAD. A study of the intraoperative factors that may influence the development of EAD should be performed to address additional, related problems in the field.