Definition, Prognosis, and Complication Analysis of Early Allograft Dysfunction in Pediatric Liver Transplantation: A...

The definition of early allograft dysfunction (EAD) varies, and has hardly been studied in pediatric transplantation (pLT) since the adult EAD definition is not easily applicable to pLT.

A retrospective analysis was conducted on consecutive pLT patients aged <18 at the Department of Pediatric Transplantation of Tianjin First Central Hospital from April 2013 to December 2022. The definition of EAD explored in this study is (1) international normalized ratio ≥2.8 on day 1 and aspartate aminotransferase >1500 IU/mL within the first 7 days or (2) total bilirubin ≥5 mg/dL on day 7. The overall survival of patients and graft survival at 90 days after surgery were compared between this new definition and the adult EAD definition.

A total of 1620 pLT recipients were included in the study, of which 179 (11.0 %) recipients met the new definition of EAD for pLT. Twenty-five (13.97 %) died and 37 (20.67 %) graft lost within 90 days. The RR_death under Olthoff's EAD definition and our EAD definition are 3.45 and 9.57, respectively; The RR_graft_loss under Olthoff's EAD definition and our EAD definition are 4.18 and 11.48, respectively. A total of 97 (18.98 %) of 511 recipients who received deceased donor liver transplantation (DDLT) met the new definition of EAD, 18 (18.56 %) died and 29 (29.90 %) graft lost within 90 days. In DDLT group, the RR_death under Olthoff's EAD definition and our EAD definition are 2.29 and 10.98, respectively; The RR_graft_loss under Olthoff's EAD definition and our EAD definition are 2.34 and 11.24, respectively.

The broadly used Olthoff's EAD definition in adult liver transplantation is unsuitable for pLT use. The EAD definition established in this study is more suitable for patients <18 years old who received pLT, especially those <18 years old who received DDLT.