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Low serum factor V level: early predictor of allograft failure and death following liver transplantation

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Abstract

Purpose

According to the current criteria, the diagnosis of early allograft dysfunction usually cannot be established before the end of the first week after liver transplantation. Thus, early predictive tests for detecting allograft dysfunction are still warranted to prevent allograft failure. This study was undertaken to assess the role of low serum factor V activity as an early prognostic factor (postoperative day 2) after liver transplantation.

Methods

A retrospective review of all consecutive adult patients who underwent first orthotopic whole-graft liver transplant at our institution between March 2002 and June 2011 was undertaken. Primary endpoint was graft failure within 90 days after transplantation.

Results

Of all 105 patients analyzed in this study, 39 (37.1 %) were female and 66 (62.9 %) were male. Mean age was 52.7 ± 11.7 years, and median follow-up period was 2474 ± 164 days. There were overall 33 (31.4 %) deaths, 13 of those occurring on the first 90 post-transplant days. Multivariate analysis demonstrated that serum factor V lower than 41.5 % and female gender had a negative impact not only on allograft failure/death within 90 days after transplantation (RR = 5.30, CI = 1.40–20.2, p = 0.015 and RR = 5.23, CI = 1.53–21.33, p = 0.008) but also on overall mortality. For prediction of allograft failure/death occurring during the first 3 months, serum factor V level of 41.5 % or lower exhibited a specificity of 87.9 %, a sensitivity of 42.9 %, an accuracy of 81.9 %, a positive predictive value of 35.3 %, and a negative predictive value of 90.9 %.

Conclusions

Assessment of serum factor V levels on postoperative day 2 might be a promising prognostic tool for early prediction of inferior outcomes after liver transplantation.

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Abbreviations

ALT:

Alanine aminotransferase

AST:

Aspartate aminotransferase

EAD:

Early allograft dysfunction

FFP:

Fresh frozen plasma

MELD score:

Model for End-Stage Liver Disease

POD:

Postoperative day

RBC:

Red blood cell unit

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Conflicts of Interest

None.

Compliance with Ethical Standards

All patients consented before being included in this study. This study complies with ethical standards and was approved by the local IRB committee.

Authorship

M.C.Z. participated in study conception and design, acquisition of the research data, analysis and interpretation of data, and writing of the manuscript; M.F.C and C.R.P.K. participated in study conception and design, analysis and interpretation of data, and writing of the manuscript; L.S.G. participated in study conception and design, analysis and interpretation of data, and critical revision of the manuscript; A.D.C., T.J.M.G.F., I.L., A.A, M.R.A.S., M.G.C., and C.D.P.K. participated in study conception and design, analysis and interpretation of data, and critical revision of the manuscript.

Funding

This study was not supported by any funding.

Author information

Authors and Affiliations

  1. Liver and Pancreas Transplant and Hepatobiliary Surgery Unit, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul (UFRGS), Av. Ramiro Barcelos 2.350, 90035-903, Porto Alegre, RS, Brazil

    Mauricio C. Zulian, Marcio F. Chedid, Aljamir D. Chedid, Tomaz J. M. Grezzana Filho, Ian Leipnitz, Cleber D. P. Kruel & Cleber R. P. Kruel

  2. Division of Gastroenterology and Hepatology, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil

    Alexandre de Araujo & Mario R. Alvares-da-Silva

  3. Intensive Care Unit, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil

    Mario G. Cardoni

  4. Division of Medical Statistics, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil

    Luciano S. Guimaraes

Authors
  1. Mauricio C. Zulian
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  2. Marcio F. Chedid
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  3. Aljamir D. Chedid
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  4. Tomaz J. M. Grezzana Filho
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  5. Ian Leipnitz
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  6. Alexandre de Araujo
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  7. Mario R. Alvares-da-Silva
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  8. Mario G. Cardoni
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  9. Luciano S. Guimaraes
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  10. Cleber D. P. Kruel
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  11. Cleber R. P. Kruel
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Corresponding author

Correspondence to Marcio F. Chedid.

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Zulian, M.C., Chedid, M.F., Chedid, A.D. et al. Low serum factor V level: early predictor of allograft failure and death following liver transplantation. Langenbecks Arch Surg 400, 589–597 (2015). https://doi.org/10.1007/s00423-015-1290-2

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  • DOI: https://doi.org/10.1007/s00423-015-1290-2

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