A Research On Risk Factors Of Early Allograft Dysfunction After Liver Transplantation With Donation After Cardiac Death Livers

Objectives:This research analyzes the possible risk factors of EAD after DCD liver transplantation,including donor liver,recipient and surgical factors,to evaluate and predict the occurrence of EAD after DCD liver transplantation.And to provide reference and observation index for clinical prevention and treatment of EAD after DCD liver transplantation.Thus improve the prognosis of DCD liver transplantation.Methods:We analyzed the data of 73 cases receiving DCD liver transplantation from September 2010 to June 2020 and divided them into the EAD group and the Non-EAD group.The average age when they received the transplantation surgery is 44.7.We collected and compared the perioperative indexes of the two groups of donors and recipients.Among them there are 16 perioperative indexes of the recipients and 6 perioperative indexes of the donors.Single factor analysis and Logistic multivariate regression analysis were performed for the target risk factors to study the independent risk factors of EAD and their effects on recipient prognosis.Results:There are 17 cases of EAD among 73 DCD liver transplantation cases.The occurrence rate of EAD is 23.3%.Among the 17 cases of EAD,3 of them in which the recipients’peak values of ALT are greater than 2000U/L during the first week after the surgery,8 of them in which the recipients’peak values of AST are greater than 2000U/L and 1 of them in which the recipient’s peak value of both ALT and AST are greater than 2000U/L during the first week after the surgery.There are 2 cases in which the recipients’peak values of TB are greater than 10mg/dL and 1 case in which the recipient’s peak value of INR is greater than 1.6 on postoperative day 7.1n the other 2 cases,the recipients’peak values of TB are greater than 10mg/dL on postoperative day 7 and peak values of AST are greater than 2000U/L during the first week after the surgery.Logistic multivariate regression analysis indicates that cold ischemia time(OR=1.19,95%CI=1.14-1.30,P=0.027)and advanced age of the donor(OR=1.75,95%CI=1.20-1.79,P=0.043)are independent risk factors of EAD after DCD liver transplantation.Conclusions:The occurrence of EAD after DCD liver transplantation is affected by multiple factors.EAD affects the prognosis of the recipient and the graft.This study indicates that long cold ischemia time and advanced age of the donor are independent risk factors of EAD after DCD liver transplantation.Controlling the upper age limit of the donor and minimizing the time of cold ischemia can reduce the occurrence of EAD and improve the prognosis of the recipients.