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Model for early allograft function is predictive of early graft loss in donation after circulatory death liver transplantation |
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| Authors: | James A. Richards Ahmed E. Sherif Andrew J. Butler Fiona Hunt Michael Allison Gabriel C. Oniscu Christopher J. E. Watson |
| Affiliation: | 1. University of Cambridge Department of Surgery, Addenbrooke's Hospital, Cambridge, UK;2. Edinburgh Transplant Centre, Royal Infirmary of Edinburgh, Edinburgh, UK;3. University of Cambridge Department of Surgery, Addenbrooke's Hospital, Cambridge, UK The NIHR Blood and Transplant Research Unit (BTRU) at the University of Cambridge in collaboration with Newcastle University and in partnership with NHS Blood and Transplant (NHSBT), Cambridge, UK The National Institute of Health Research (NIHR) Cambridge Biomedical Research Centre, Cambridge, UK;4. The National Institute of Health Research (NIHR) Cambridge Biomedical Research Centre, Cambridge, UK Department of Medicine, Cambridge University Hospitals, Addenbrooke’s Hospital, Cambridge, UK;5. Edinburgh Transplant Centre, Royal Infirmary of Edinburgh, Edinburgh, UK Department of Clinical Surgery, University of Edinburgh, Edinburgh, UK |
| Abstract: | Donation after circulatory death (DCD) liver transplantation is associated with higher rates of graft loss. In this paper, we explored whether the Model for Early Allograft Function (MEAF) predicted outcome in DCD liver transplantation. We performed a retrospective analysis of prospectively collected data from all adult DCD (Maastricht 3) livers transplanted in Cambridge and Edinburgh between 1 January 2011 and 30 June 2017, excluding those undergoing any form of machine perfusion. 187 DCD liver transplants were performed during the study period. DCD liver transplants with a lower MEAF score had a significantly better survival compared to those with a high MEAF score (Mantel-Cox P < .0001); this was largely due to early graft loss. Beyond 28 days post-transplant, there were no significant long-term graft or patient survival differences irrespective of the grade of MEAF (Mantel-Cox P = .64 and P = .43, respectively). The MEAF score correlated with the length of ICU (P = .0011) and hospital stay (P = .0007), but did not predict the requirement for retransplantation for ischemic cholangiopathy (P = .37) or readmission (P = .74). In this study, a high MEAF score predicted early graft loss, but not the subsequent need for re-transplantation or late graft failure as a result of intrahepatic ischemic bile duct pathology. |
| Keywords: | donation after circulatory death early allograft dysfunction liver failure liver transplantation post-transplant survival |