Coexistence of Bilirubin >=10 mg/dL and Prothrombin Time-International Normalized Ratio >=1.6 on Day 7: A Strong Predictor of Early Graft Loss after Living Donor Liver Transplantation.

Background: Early allograft dysfunction (EAD) defined by serum total bilirubin (TB) >=10 mg/dL or prothrombin time-international normalized ratio (PT-INR) >=1.6 on postoperative day 7 (POD7) or aminotransferase >2000 IU/L within the first week, is associated with early graft loss after deceased-donor liver transplantation. We aimed to determine the prognostic impact of the EAD definition in living-donor liver transplantation (LDLT). Methods: We analyzed the validity of the EAD definition and its impact on early graft survival in 260 adult recipients who underwent primary LDLT. Results: Eighty-four (32.3%) patients met the EAD criteria; 59 (22.7%) and 46 (17.7%) patients had TB >=10 mg/dL and PT-INR >=1.6 on POD7, respectively, and 22 (8.5%) patients satisfied both criteria. Graft survival differed significantly when stratified according to TB >=10 mg/dL and PT-INR >=1.6 (p=1.6 resulted in higher graft mortality (RR=3.87, p<.0001 at rr="2.97," p as did tb>=10 mg/dL (RR=1.89, p=0.027 at 90-day; RR=1.91, p=0.006 at 180-day). Coexistence of TB >=10 mg/dL and PT-INR >=1.6 was strongly associated with early graft loss (59.1%, RR=6.97 at 90-day; 68.2%, RR=5.75 at 180-day). In Cox regression analysis, PT-INR >=1.6 and TB >=10 mg/dL on POD7 were significant risk factors for early graft loss (hazard ratio =4.10 [95% CI: 2.35-7.18], p=10 mg/dL and/or PT-INR >=1.6 on POD7 predicted early graft loss after LDLT, and their coexistence worsened patient outcomes. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

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