Graft weight integration in the early allograft dysfunction formula improves the prediction of early graft loss after liver transplantation

Abstract

The role of the graft-to-recipient weight ratio (GRWR) in adult liver transplantation (LT) has been poorly investigated so far. The aim is to evaluate the contribution of the GRWR to the well-recognized early allograft dysfunction (EAD) model (i.e., Olthoff model) for the prediction of 90-day graft loss after LT in adults. Three hundred thirty-one consecutive adult patients undergoing LT between 2009 and 2018 at Tor Vergata and Sapienza University in Rome, Italy, served as the Training-Set. The Validation-Set included 123 LTs performed at the Erasmus Medical Center, Rotterdam, the Netherlands. The mEAD model for 90-day graft loss included the following variables: GRWR [Formula: see text] 1.57 = 2.5, GRWR [Formula: see text] 2.13 = 2.5, total bilirubin ≥ 10.0 mg/dL = 2.0, INR ≥ 1.60 = 2.3, and aminotransferase > 2000 IU/L = 2.2. The mEAD model showed an AUC = 0.74 (95%CI = 0.66-0.82; p < 0.001) and AUC = 0.68 (95%CI = 0.58-0.88; p = 0.01) in the Training-Set and Validation-Set, respectively, outperforming conventional EAD in both cohorts (Training-Set: AUC = 0.64, 95%CI = 0.57-0.72; p = 0.001; Validation-Set: AUC = 0.52, 95%CI = 0.35-0.69, p = 0.87). Incorporation of graft weight in a composite multivariate model allowed for better prediction of patients who presented an aminotransferase peak > 2000 IU/L after LT (OR = 2.39, 95%CI = 1.47-3.93, p = 0.0005). The GRWR is important in determining early graft loss after adult LT, and the mEAD model is a useful predictive tool in this perspective, which may assist in improving the graft allocation process.

Keywords: Early allograft dysfunction; Graft loss; Graft weight; Liver transplantation.

Conflict of interest statement

None.

© 2022. The Author(s).

Figures

Fig. 1

Evaluation and comparison of the m-EAD and EAD predicting models on 90-day graft loss [Training-SET (A) and Validation-SET (B)]

Fig. 2

Relative risk of 90-day graft loss according to the GRWR. The histograms represent the Training-Set population distribution according to the GRWR (reported on the right y-axis). The left y-axis shows the 90-day graft loss incidence (%). The line represents the relative risk (RR) of 90-day graft loss according to the GRWR. The GRWR RR = 1 represents the reference (median GRWR value = 1.9); the “red zone” represents the increase in the RR of 90-day graft loss when the GRWR > 2.0. Contrarily, the “green zone” represents the decrease in the risk (from GRWR = 1.57 to GRWR = 2.0). The RR curve remains stable (RR ∼ 5) when GRWR < 1.6 (yellow zone)

Fig. 3

Relative risk of 90-day graft loss according to the mEAD. The histograms represent the Training-Set population distribution according to the mEAD (reported on the right y-axis). The left y-axis shows the 90-day graft loss incidence (%). The line represents the relative risk (RR) of 90-day graft loss according to the mEAD. The mEAD RR = 1 represents the reference. (median mEAD value = 4.3)