The severity of immediate hepatocellular damage in the first two days after liver transplantation predicts long-term graft survival.
5 affiliations
- 1Department of Translational and Precision Medicine, Sapienza University of Rome, Viale dell'Università 37, Rome, 00185, Italy.
- 2Organ Transplantation Unit, Department of General and Specialty Surgery, Sapienza University of Rome, AOU Policlinico Umberto I, Viale del Policlinico 155, Rome, 00161, Italy.
- 3Department of Molecular Medicine, Sapienza University of Rome, Viale Regina Elena 324, Rome, 00161, Italy.
- 4Department of Anesthesia and Critical Care Medicine, Sapienza University of Rome, Policlinico Umberto I, Viale del Policlinico 155, Rome, 00161, Italy.
- 5Department of Translational and Precision Medicine, Sapienza University of Rome, Viale dell'Università 37, Rome, 00185, Italy. [email protected].
Abstract
Background
Early allograft dysfunction (EAD) is associated with graft loss up to 5-years after liver transplantation (LT), but longer follow-up data are not available. We investigated which laboratory tests used in the diagnosis of EAD were most strongly associated with long-term LT outcome.Methods
We enrolled 101 consecutive HCV-negative adult patients, who underwent their first non-urgent LT between 2001 and 2011. Demographic and clinical data, including graft steatosis on pre-ischemia protocol biopsy, were collected for both recipient and donor.Results
The median follow-up was 13.7 years. Among the laboratory tests used for the diagnosis of EAD, graft loss was more strongly associated with serum aminotransferase on the first two postoperative days (POD) than with INR and total bilirubin on POD7. In multivariate Cox analysis, graft loss was associated with a new index of immediate hepatocellular damage (IHD), calculated as the sum of AST and ALT on POD1 and POD2 (HR = 3.27, CI: 1.51-7.08, p = 0.0001), outperforming EAD (HR = 2.27, CI: 1.11-4.62, p = 0.020). Risk factors for IHD were older transplant era, recipient obesity, and graft large droplet steatosis (15%).Conclusions
IHD is a strong predictor of long-term graft loss after LT and outperform traditional EAD criteria. Steatotic grafts should increasingly be subjected to defatting methods, and their use should be limited in obese recipients.
Related
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- Muscle and tissue radiodensity matter: Automated CT-based body composition analysis predicts survival in hepatocellular carcinoma patients undergoing degradable starch microspheres transarterial chemoembolization (DSM-TACE)
- Innovative magnetic anastomosis enables immediate liver transplantation without cold preservation
- Impact of Hepatic Artery Diameter on Immediate Postoperative Graft Function and Hemodynamic Profiles in Living-Donor Liver Transplantation: A Retrospective Cohort Study
BibTeX
@article{ferri2026severity,
title = {{The severity of immediate hepatocellular damage in the first two days after liver transplantation predicts long-term graft survival.}},
author = {Flaminia Ferri and Simona Parisse and Quirino Lai and Fabio Melandro and Gianluca Mennini and Alessandro Corsi and Mara Riminucci and Francesco Pugliese and Manuela Merli and Massimo Rossi and Stefano Ginanni Corradini},
journal = {BMC gastroenterology},
year = {2026},
month = aug,
doi = {10.1186/s12876-026-05182-w},
url = {https://europepmc.org/article/MED/42972264},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - The severity of immediate hepatocellular damage in the first two days after liver transplantation predicts long-term graft survival.
AU - Flaminia Ferri
AU - Simona Parisse
AU - Quirino Lai
AU - Fabio Melandro
AU - Gianluca Mennini
AU - Alessandro Corsi
AU - Mara Riminucci
AU - Francesco Pugliese
AU - Manuela Merli
AU - Massimo Rossi
AU - Stefano Ginanni Corradini
PY - 2026
DA - 2026/08/01
JO - BMC gastroenterology
DO - 10.1186/s12876-026-05182-w
UR - https://europepmc.org/article/MED/42972264
AB - Background Early allograft dysfunction (EAD) is associated with graft loss up to 5-years after liver transplantation (LT), but longer follow-up data are not available. We investigated which laboratory tests used in the diagnosis of EAD were most strongly associated with long-term LT outcome.Methods We enrolled 101 consecutive HCV-negative adult patients, who underwent their first non-urgent LT between 2001 and 2011. Demographic and clinical data, including graft steatosis on pre-ischemia protocol biopsy, were collected for both recipient and donor.Results The median follow-up was 13.7 years. Among the laboratory tests used for the diagnosis of EAD, graft loss was more strongly associated with serum aminotransferase on the first two postoperative days (POD) than with INR and total bilirubin on POD7. In multivariate Cox analysis, graft loss was associated with a new index of immediate hepatocellular damage (IHD), calculated as the sum of AST and ALT on POD1 and POD2 (HR = 3.27, CI: 1.51-7.08, p = 0.0001), outperforming EAD (HR = 2.27, CI: 1.11-4.62, p = 0.020). Risk factors for IHD were older transplant era, recipient obesity, and graft large droplet steatosis (15%).Conclusions IHD is a strong predictor of long-term graft loss after LT and outperform traditional EAD criteria. Steatotic grafts should increasingly be subjected to defatting methods, and their use should be limited in obese recipients.
SN - 1471-230X
ER -