Retrospective Cohort Study
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Hepatol. Sep 27, 2019; 11(9): 689-700
Published online Sep 27, 2019. doi: 10.4254/wjh.v11.i9.689
Hepatic flow is an intraoperative predictor of early allograft dysfunction in whole-graft deceased donor liver transplantation: An observational cohort study
Pablo Lozano Lominchar, Maitane Igone Orue-Echebarria, Lorena Martín, Cristina Julia Lisbona, María Magdalena Salcedo, Luis Olmedilla, Hemant Sharma, Jose Manuel Asencio, José Ángel López-Baena
Pablo Lozano Lominchar, Maitane Igone Orue-Echebarria, Lorena Martín, Jose Manuel Asencio, José Ángel López-Baena, General Surgery Department, Liver Transplant Unit, Hospital General Universitario Gregorio Maranon, Madrid 28007, Spain
Cristina Julia Lisbona, Luis Olmedilla, Anesthesiology Department, Liver Transplant Unit, Hospital General Universitario Gregorio Maranon, Madrid 28007, Spain
María Magdalena Salcedo, Hepatology Department, Liver Transplant Unit, Hospital General Universitario Gregorio Maranon, Madrid 28007, Spain
Hemant Sharma, Department of Transplant Surgery, Oschner Medical Center, New Orleans, LA 70816, United States
Author contributions: Lozano P and Baena JAL participated in research design; Lozano P and Orue-Echebarria LM participated in data analysis; Lozano P, Baena JAL, Olmedilla L, Asencio JM, Salcedo MM and Lisbona CJ carried out the research; Lozano P, Sharma H and Martin L wrote the paper.
Institutional review board statement: This clinical research study was approved by the Hospital General Universitario Gregorio Maranon Local Ethical Committee.
Informed consent statement: A consent form was signed by or on behalf of each patient enrolled in the study.
Conflict-of-interest statement: None of the authors have any conflicts of interest to disclose.
STROBE statement: The STROBE Statement had been adopted.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Corresponding author: Pablo Lozano, MD, PhD, General Surgery Department, Liver Transplant Unit, Hospital Universitario Gregorio Maranon, C/ Doctor Esquerdo 44, Madrid 28007, Spain.
Telephone: +34-639-011522
Received: April 13, 2019
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.

Keywords: Hepatic flow, Early allograft dysfunction, Liver transplant

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.