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Identifying independent risk factors for graft loss after primary liver transplantation

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Abstract

Purpose

The aim of the study is the identification of independent risk factors for re-transplantation after primary liver transplantation beyond the occurrence of hepatic artery thrombosis.

Methods

Eight hundred thirty-four adult patients undergoing primary liver transplantation were analyzed. A propensity score was developed using multivariable binary logistic regression with hepatic artery thrombosis as the dependent variable. The logit link function of the propensity score was included into multivariable Cox regression analysis for graft survival to adjust the study population.

Results

Graft loss was observed in 134 patients (16.1%). Independent significant risk factors for graft loss were recipient platelet count (p = 0.040; HR: 1.002; 95%-CI: 1.000–1.003), preoperative portal vein thrombosis (p = 0.032; HR: 1.797; 95%-CI: 1.054–2.925), donor age (p < 0.001; HR: 1.026; 95%-CI: 1.012–1.040), percentage of macrovesicular steatosis of the graft (p = 0.011; HR: 1.037; 95%-CI: 1.009–1.061), early complications leading to revision surgery (p < 0.001; HR: 2.734; 95%-CI: 1.897–3.956), duration of the transplant procedure (p < 0.001; HR: 1.005; 95%-CI: 1.003–1.007) as well as transplantation of a split liver graft (p = 0.003; HR: 2.637; 95%-CI: 1.420–4.728). The logit of the propensity score did not reach statistical significance in the final multivariable Cox regression model (p = 0.111) indicating good adjustment for the occurrence of hepatic artery thrombosis.

Conclusion

Liver transplant programs might benefit from regular donor organ biopsies to assess the amount of macrovesicular steatosis. An elevated recipient platelet count can promote reperfusion injury leading to graft loss. A liver graft from an elderly donor should not be split or be transplanted in a recipient with detected portal vein thrombosis.

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Acknowledgements

Grants and financial support

This work was supported by a grant from the German Federal Ministry of Education and Research (reference number 01EO1302).

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Authors and Affiliations

  1. Core Facility Quality Management and Health Technology Assessment in Transplantation, Integrated Research and Treatment Center-Transplantation (IFB-Tx), Hannover Medical School, Carl-Neuberg Str. 1, 30625, Hannover, Germany

    Jill Gwiasda, Harald Schrem & Alexander Kaltenborn

  2. Department of General, Visceral and Transplant Surgery, Hannover Medical School, Hannover, Germany

    Harald Schrem & Jürgen Klempnauer

  3. Department of Trauma and Orthopaedic Surgery, Federal Armed Forces Hospital Westerstede, Westerstede, Germany

    Alexander Kaltenborn

Authors
  1. Jill Gwiasda
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  2. Harald Schrem
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  3. Jürgen Klempnauer
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  4. Alexander Kaltenborn
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Contributions

J. G, H. S, J. K and A. K participated in the study conception and design and critical revision of the manuscript. J. G, H. S and A. K participated in the acquisition of data, analysis and interpretation of data, and drafting of the manuscript.

Corresponding author

Correspondence to Jill Gwiasda.

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The authors declare that they have no conflict of interest.

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Informed consent was obtained from all individual participants included in the study.

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Gwiasda, J., Schrem, H., Klempnauer, J. et al. Identifying independent risk factors for graft loss after primary liver transplantation. Langenbecks Arch Surg 402, 757–766 (2017). https://doi.org/10.1007/s00423-017-1594-5

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  • DOI: https://doi.org/10.1007/s00423-017-1594-5

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