A Predictive Nomogram For Early Allograft Dysfunction In Liver Transplantation With Donation After Cardiac Death

Background:Early allograft dysfunction(EAD)is associated with inferior patient and allograft survival.In order to develop strategies for the prevention of EAD,we evaluated risk factors for EAD in recipients who obtained allografts from donation after cardiac death(DCD)donors.Methods:This study included 323 liver transplantation(LT)recipients.Donor,recipient and operative data associated with EAD or graft survival were analyzed using binary logistic regression and Cox proportional hazard analysis to identify significant risk factors and to establish a predictive nomogram for EAD.Results:Of the 323 LT recipients,142(43.96%)developed EAD.Macrovesicular steatosis?20%(P=0.021),donor serum sodium(P<0.001),donor body mass index(BMI;P=0.010),and recipient pre-LT Model for End-stage Liver Disease(MELD)score(P=0.030)were found to be independent risk factors for the development of EAD.We constructed a predictive nomogram based on independent risk factors and their regression coefficients,the C-index for EAD prediction was 0.707(95%Cl,0.64 to 0.77).Multivariate Cox proportional hazard regression analysis showed that EAD(P=0.015),donor age(P=0.006)and operative blood loss(P<0.001)were independent predictors of impaired graft survival.Conclusions:EAD,donor age and operative blood loss shown to be independent predictors of inferior graft survival.EAD can be predicted using a combination of risk factors,including the proportion of macrovesicular steatosis,donor serum sodium,donor BMI and recipient pre-LT MELD score.This predictive nomogram may facilitate early identification and management of this complication.