Value of Factor V in the diagnosis of early graft dysfunction after liver transplantation: Internal validation

Primary graft dysfunction is a major early complication following liver transplantation, potentially leading to retransplantation or patient death. Coagulation Factor V (FV) and ALT have emerged as important biomarkers in assessing liver function, yet their role as early predictors of graft loss has not been fully validated. The aim of this study is to conduct an internal validation of published results on the applicability of FV and ALT for diagnosing graft dysfunction and its predictive ability for graft loss within the first 90 days. We conducted a retrospective cohort study including 513 adult recipients from 2012 to 2023 at the Regional University Hospital of Málaga. FV and ALT levels were measured on postoperative day 2, and patients were categorized based on FV <37.5 and ALT >1539. The association with 90-day graft loss was analyzed. Graft loss occurred in 43 patients (8.4%) within the first 90 days. The combination of FV <37.5 and ALT >1539 on postoperative day 2 demonstrated a specificity of 99% and a test efficiency of 94% in predicting graft loss. Patients meeting both criteria had a 74-fold increased risk of graft loss, with most losses occurring within the first week, and a median survival of 4 days. These findings suggest that FV and ALT on postoperative day 2 are reliable early markers for predicting graft loss, enabling risk stratification and guiding critical decisions regarding early retransplantation in the immediate postoperative period.