Predicting Early Graft Dysfunction and Mortality After Liver Transplant Using the De Ritis Ratio

Area of Science:

• Hepatology
• Transplantation Surgery
• Medical Informatics

Background:

• Predicting post-liver transplantation (LT) complications, including early allograft dysfunction (EAD) and mortality, remains a significant clinical challenge.
• Current predictive models often lack comprehensive assessment of key indicators of liver dysfunction.

Purpose of the Study:

• To evaluate the utility of the De Ritis ratio (DRR), a marker of liver dysfunction, in predicting EAD and mortality after LT.
• To incorporate DRR into existing or novel scoring systems for enhanced predictive accuracy.

Main Methods:

• A retrospective chart review of 132 adult deceased donor LT recipients and their donors was performed.
• Donor characteristics, postoperative liver function, and DRR were analyzed for correlation with EAD, Clavien-Dindo scores (post-transplant complications), and 30-day mortality.

Main Results:

• EAD occurred in 26.5% of patients, and 30-day mortality was 7.6%.
• Factors associated with EAD included donation after circulatory death, high donor risk index (DRI), ischemic injury, and prolonged warm ischemia time.
• The developed Gala-Lopez score, integrating DRI, bilirubin, and DRR on postoperative day 5, accurately predicted EAD (75%), high Clavien-Dindo scores (81%), and 30-day mortality (64%).

Conclusions:

• The De Ritis ratio (DRR) should be considered as a vital component in predictive models for EAD, severe complications, and 30-day mortality post-LT.
• Further research is necessary to validate these findings and assess their applicability with emerging perfusion technologies.