Agopian VG, et al. - Researchers, in this study, sought to develop a model for individualized risk estimation of graft failure after liver transplantation (LT). In addition, they compared the model’s prognostic performance with the existing binary early allograft dysfunction (EAD) definition (bilirubin level of ≥10 mg/dL on postoperative day 7, international normalized ratio of ≥1.6 on postoperative day 7, or aspartate aminotransferase or alanine aminotransferase level of >2000 U/L within the first 7 days) and the Model for Early Allograft Function (MEAF) score. Following LT, individualized risk estimation of 3-month graft failure was highly accurate with the Liver Graft Assessment Following Transplantation (L-GrAFT) risk score, it proved more accurate than existing EAD and MEAF scores. For the adoption of the L-GrAFT as a tool for evaluating the need for a retransplant, for establishing standardized grading of early allograft function across transplant centers, and as a highly accurate clinical end point in translational studies aiming to mitigate ischemia or reperfusion injury by modulating donor quality and recipient factors, multicenter validation is considered to be needed.

Methods

• Researchers performed a retrospective single-center analysis using a transplant database to identify all adult patients who underwent a primary LT and had data on 10 days of post-LT laboratory variables at the Dumont-UCLA Transplant Center of the David Geffen School of Medicine at UCLA between February 1, 2002, and June 30, 2015.
• From January 4, 2016 to June 30, 2016, they performed data collection.
• From July 1, 2016 to August 30, 2017, they performed data analysis.
• They measured 3-month graft failure–free survival.

Results

• Over the study period 2,021 patients underwent primary LT.
• Of these, 2,008 (99.4%) had available perioperative data and were included in the analysis.
• Data revealed that the median (interquartile range [IQR]) age of recipients was 56 (49-62) years, and 1,294 recipients (64.4%) were men.
• With an 11.1% (222 recipients) incidence of 3-month graft failure or death, overall survival and graft-failure-free survival rates were 83% and 81% at year 1, 74% and 71% at year 3, and 69% and 65% at year 5.
• Post-LT aspartate aminotransferase level, international normalized ratio, bilirubin level, and platelet count were identified as the multivariate factors associated with 3-month graft failure–free survival; measures of these were used to calculate the Liver Graft Assessment Following Transplantation (L-GrAFT) risk score.
• With a significantly superior discrimination of 3-month graft failure–free survival, the L-GrAFT model had an excellent C statistic of 0.85 in comparison with the existing EAD definition (C statistic, 0.68; P < .001) and the MEAF score (C statistic, 0.70; P < .001).
• Findings revealed that in comparison with patients with lower L-GrAFT risk, LT recipients in the highest 10th percentile of L-GrAFT scores indicated higher Model for End-Stage Liver Disease scores (median [IQR], 34 [26-40] vs 31 [25-38]; P=.005); greater need for pretransplant hospitalization (56.8% vs 44.8%; P=.003), renal replacement therapy (42.9% vs 30.5%; P < .001), mechanical ventilation (35.8% vs 18.1%; P < .001), and vasopressors (22.9% vs 11.0%; P < .001); longer cold ischemia times (median [IQR], 436 [311-539] vs 401 [302-506] minutes; P=.04); greater intraoperative blood transfusions (median [IQR], 17 [10-26] vs 10 [6-17] units of packed red blood cells; P < .001); and older donors (median [IQR] age, 47 [28-56] vs 41 [25-52] years; P < .001).