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Moore HB, Saben J, Rodriguez I, Bababekov YJ, Pomposelli JJ, Yoeli D, Ferrell T, Adams MA, Pshak TJ, Kaplan B, Pomfret EA, Nydam TL. Postoperative fibrinolytic resistance is associated with early allograft dysfunction in liver transplantation: A prospective observational study. Liver Transpl 2023; 29:724-734. [PMID: 36749288 PMCID: PMC10293055 DOI: 10.1097/lvt.0000000000000075] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Indexed: 02/08/2023]
Abstract
Perioperative dysfunction of the fibrinolytic system may play a role in adverse outcomes for liver transplant recipients. There is a paucity of data describing the potential impact of the postoperative fibrinolytic system on these outcomes. Our objective was to determine whether fibrinolysis resistance (FR), on postoperative day one (POD-1), was associated with early allograft dysfunction (EAD). We hypothesized that FR, quantified by tissue plasminogen activator thrombelastography, is associated with EAD. Tissue plasminogen activator thrombelastography was performed on POD-1 for 184 liver transplant recipients at a single institution. A tissue plasminogen activator thrombelastography clot lysis at 30 minutes of 0.0% was identified as the cutoff for FR on POD-1. EAD occurred in 32% of the total population. Fifty-nine percent (n=108) of patients were categorized with FR. The rate of EAD was 42% versus 17%, p <0.001 in patients with FR compared with those without, respectively. The association between FR and EAD risk was assessed using multivariable logistic regression after controlling for known risk factors. The odds of having EAD were 2.43 times (95% CI, 1.07-5.50, p =0.03) higher in recipients with FR [model C statistic: 0.76 (95% CI, 0.64-0.83, p <0.001]. An additive effect of receiving a donation after circulatory determination of death graft and having FR in the rate of EAD was observed. Finally, compared with those without FR, recipients with FR had significantly shorter graft survival time ( p =0.03). In conclusion, FR on POD-1 is associated with EAD and decreased graft survival time. Postoperative viscoelastic testing may provide clinical utility in identifying patients at risk for developing EAD, especially for recipients receiving donation after circulatory determination of death grafts.
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Affiliation(s)
- Hunter B Moore
- Departments of Surgery, University of Colorado Denver, Anschutz Medical Campus, Aurora, Colorado
- Colorado Center for Transplantation Care, Research and Education (CCTCARE), Aurora, Colorado
- Department of Surgery, Children’s Hospital Colorado, Aurora, Colorado
| | - Jessica Saben
- Departments of Surgery, University of Colorado Denver, Anschutz Medical Campus, Aurora, Colorado
- Colorado Center for Transplantation Care, Research and Education (CCTCARE), Aurora, Colorado
| | - Ivan Rodriguez
- Departments of Surgery, University of Colorado Denver, Anschutz Medical Campus, Aurora, Colorado
- Colorado Center for Transplantation Care, Research and Education (CCTCARE), Aurora, Colorado
| | - Yanik J Bababekov
- Departments of Surgery, University of Colorado Denver, Anschutz Medical Campus, Aurora, Colorado
- Colorado Center for Transplantation Care, Research and Education (CCTCARE), Aurora, Colorado
| | - James J Pomposelli
- Departments of Surgery, University of Colorado Denver, Anschutz Medical Campus, Aurora, Colorado
- Colorado Center for Transplantation Care, Research and Education (CCTCARE), Aurora, Colorado
| | - Dor Yoeli
- Departments of Surgery, University of Colorado Denver, Anschutz Medical Campus, Aurora, Colorado
- Colorado Center for Transplantation Care, Research and Education (CCTCARE), Aurora, Colorado
| | - Tanner Ferrell
- Departments of Surgery, University of Colorado Denver, Anschutz Medical Campus, Aurora, Colorado
- Colorado Center for Transplantation Care, Research and Education (CCTCARE), Aurora, Colorado
| | - Megan A Adams
- Departments of Surgery, University of Colorado Denver, Anschutz Medical Campus, Aurora, Colorado
- Colorado Center for Transplantation Care, Research and Education (CCTCARE), Aurora, Colorado
- Department of Surgery, Children’s Hospital Colorado, Aurora, Colorado
| | - Thomas J Pshak
- Departments of Surgery, University of Colorado Denver, Anschutz Medical Campus, Aurora, Colorado
- Colorado Center for Transplantation Care, Research and Education (CCTCARE), Aurora, Colorado
| | - Bruce Kaplan
- Departments of Surgery, University of Colorado Denver, Anschutz Medical Campus, Aurora, Colorado
- Colorado Center for Transplantation Care, Research and Education (CCTCARE), Aurora, Colorado
| | - Elizabeth A Pomfret
- Departments of Surgery, University of Colorado Denver, Anschutz Medical Campus, Aurora, Colorado
- Colorado Center for Transplantation Care, Research and Education (CCTCARE), Aurora, Colorado
| | - Trevor L Nydam
- Departments of Surgery, University of Colorado Denver, Anschutz Medical Campus, Aurora, Colorado
- Colorado Center for Transplantation Care, Research and Education (CCTCARE), Aurora, Colorado
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Yi J, Zhou Z, Li Q, Chen G, He Z, Ma Y, Luo X, Si Z, Li J. Risk Factors of Early Allograft Dysfunction in Patients With Hepatitis B Virus-Related Acute-on-Chronic Liver Failure After Deceased Donor Liver Transplant. EXP CLIN TRANSPLANT 2022; 20:668-673. [DOI: 10.6002/ect.2022.0079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Ohara S, Macdonough E, Egbert L, Brooks A, Lizaola-Mayo B, Mathur AK, Aqel B, Reddy KS, Jadlowiec CC. Decreasing Significance of Early Allograft Dysfunction with Rising Use of Nonconventional Donors. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:medicina58060821. [PMID: 35744084 PMCID: PMC9227373 DOI: 10.3390/medicina58060821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Revised: 06/07/2022] [Accepted: 06/13/2022] [Indexed: 11/27/2022]
Abstract
Background and Objectives: Early allograft dysfunction (EAD) is considered a surrogate marker for adverse post-liver transplant (LT) outcomes. With the increasing use of nonconventional donors, EAD has become a more frequent occurrence. Given this background, we aimed to assess the prevalence and impact of EAD in an updated cohort inclusive of both conventional and nonconventional liver allografts. Materials and Methods: Perioperative and one-year outcomes were assessed for a total of 611 LT recipients with and without EAD from Mayo Clinic Arizona. EAD was defined as the presence of one or more of the following: bilirubin > 10 mg/dL on day 7, INR > 1.6 on day 7, or ALT and/or AST > 2000 IU/L within the first 7 days of LT. Results: Within this cohort, 31.8% of grafts (n = 194) came from donation after circulatory death (DCD) donors, 17.7% (n = 108) were nationally shared, 16.4% (n = 100) were allocated as post-cross clamp, and 8.7% contained moderate steatosis. EAD was observed in 52.2% (n = 321) of grafts in the study cohort (79% in DCD grafts and 40% in DBD grafts). EAD grafts had higher donor risk index (DRI) scores (1.9 vs. 1.6, p < 0.0001), were more likely to come from DCD donors (48% vs. 13.8%, p < 0.0001), were regionally allocated (p = 0.003), and had higher cold ischemia times (median 6.0 vs. 5.5 h, p = 0.001). Primary nonfunction events were rare in both groups (1.3% vs. 0.3%, p = 0.22). Post-LT acute kidney injury occurred at a similar frequency in recipients with and without EAD (43.6% vs. 30.3%, p = 0.41), and there were no differences in ICU (median 2 vs. 1 day, p = 0.60) or hospital (6 vs. 5 days, p = 0.24) length of stay. For DCD grafts, the rate of ischemic cholangiopathy was similar in the two groups (14.9% EAD vs. 17.5% no EAD, p = 0.69). One-year patient survival for grafts with and without EAD was 96.0% and 94.1% (HR 1.2, 95% CI 0.7−1.8; p = 0.54); one-year graft survival was 92.5% and 92.1% (HR 1.0, 95% CI 0.7−1.5; p = 0.88). Conclusions: In this cohort, EAD occurred in 52% of grafts. The occurrence of EAD, however, did not portend inferior outcomes. Compared to those without EAD, recipients with EAD had similar post-operative outcomes, as well as one-year patient and graft survival. EAD should be managed supportively and should not be viewed as a deterrent to utilization of non-ideal grafts.
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Affiliation(s)
- Stephanie Ohara
- Division of Surgery, Valleywise Health Medical Center, Creighton University, Phoenix, AZ 85008, USA;
| | - Elizabeth Macdonough
- Division of Gastroenterology and Hepatology, Mayo Clinic, Phoenix, AZ 85054, USA; (E.M.); (B.L.-M.); (B.A.)
| | - Lena Egbert
- Mayo Clinic Alix School of Medicine, Scottsdale, AZ 85259, USA;
| | - Abigail Brooks
- School of Medicine, Tel Aviv University, Tel Aviv-Yafo 6997801, Israel;
| | - Blanca Lizaola-Mayo
- Division of Gastroenterology and Hepatology, Mayo Clinic, Phoenix, AZ 85054, USA; (E.M.); (B.L.-M.); (B.A.)
| | - Amit K. Mathur
- Division of Transplant Surgery, Department of Surgery, Mayo Clinic, Phoenix, AZ 85054, USA; (A.K.M.); (K.S.R.)
| | - Bashar Aqel
- Division of Gastroenterology and Hepatology, Mayo Clinic, Phoenix, AZ 85054, USA; (E.M.); (B.L.-M.); (B.A.)
| | - Kunam S. Reddy
- Division of Transplant Surgery, Department of Surgery, Mayo Clinic, Phoenix, AZ 85054, USA; (A.K.M.); (K.S.R.)
| | - Caroline C. Jadlowiec
- Division of Transplant Surgery, Department of Surgery, Mayo Clinic, Phoenix, AZ 85054, USA; (A.K.M.); (K.S.R.)
- Correspondence: ; Tel.: +1-480-342-0437
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