Early Allograft Dysfunction After Liver Transplantation: Impact on Clinical Outcomes and Associated Risk Factors

Background and Objectives: Early allograft dysfunction (EAD), defined as suboptimal initial graft function following liver transplantation (LT), is a serious complication associated with increased post-LT morbidity and mortality. This study aimed to evaluate the impact of EAD on clinical outcomes and to identify associated risk factors. Materials and Methods: Ninety-three patients who underwent LT between July 2015 and August 2024 were retrospectively analyzed. EAD was defined by the presence of one or more of the following criteria: total bilirubin ≥ 10 mg/dL or international normalized ratio ≥ 1.6 on postoperative day 7, and alanine or aspartate aminotransferase levels > 2000 IU/L within the first 7 days. Results: EAD occurred in 20 patients (21.5%). Patients with EAD exhibited significantly lower graft survival (p < 0.01) and patient survival (p = 0.03) compared with those without EAD. EAD was an in-dependent risk factor for both graft survival (p = 0.021) and patient survival (p = 0.027). Acute liver failure (odds ratio [OR], 6.228; 95% confidence interval [CI], 1.179-32.906; p = 0.031), donor age (OR, 1.051; 95% CI, 1.008-1.096; p = 0.020), and warm ischemic time (OR, 1.048; 95% CI, 1.001-1.098; p = 0.046) were identified as significant predictors of EAD development. Conclusions: EAD adversely affects both graft and patient survival following LT. Recipient clinical status, donor age, and intraoperative conditions should be carefully considered to minimize the risk of EAD.