How to identify early graft dysfunction preoperatively?

Small-for-size graft dysfunction (SFSGD) following living-related liver transplantation (LRLT) is characterized by early graft dysfunction (EGD) when the graft-to-recipient body weight ratio (GRBWR) is below 0.8%. However, patients transplanted with GRBWR above 0.8% can develop dysfunction of the graft. A research team, led by Dr. Salvatore Gruttadauria from University of Pittsburgh analyzed a group of LRLT recipients in order to identify those who developed a clinical picture of SFSGD in the absence of a GBWR of < 0.8% and with a ratio of graft volume (GV) relative to the standard liver volume (SLV) of the recipient (GV/SLV) highest than 30%. Those patients were defined as affected by early graft dysfunction (EGD).

Their study will be published on September 28, 2009 in the World Journal of Gastroenterology.

In this study, a trend in favor of the non-EGD group (3-mo actuarial survival 98% vs 88%, P = 0.09; 3-mo graft mortality 4.7% vs 20%, P = 0.07) was observed as well as shorter length of stay (LOS) (13 d vs 41.5 d; P = 0.001) and smaller requirement of peri-operative Units of Plasma (4 vs 14; P = 0.036). Univariate analysis of pre-transplant variables identified platelet count, serum bilirubin, INR and Meld-Na score as predictors of EGD. In the multivariate analysis transplant Meld-Na score (P = 0.025, OR: 1.175) and pre-transplant platelet count (P = 0.043, OR: 0.956) were independently associated with EGD.

They drew a conclusion that a prompt recognition of EGD can trigger a timely and appropriate treatment.

Source: World Journal of Gastroenterology