Cholestasis and hypoalbuminemia as predictors of outcome after liver transplantation

WITH THE SEVERE organ shortage worldwide there has been a trend in recent years toward an increased use of liver allografts from older and otherwise suboptimal donors. The main disadvantage of this donor pool is the increased risk for primary graft non-function (PNF) on initial poor graft function (IPF) after transplantation. Whereas the criteria for retransplantation are well established for patients with PNF recipients with IPF, because of the possibility of full recovery often experience a delay in retransplantatation, which may explain the relatively high mortality rates among recipients with IPF. Several parameters have been proposed as potential prognostic markers for graft survival. Because transplant outcome depends on multiple donor, operative, and recipient factors, most predictive models lack accuracy. For patients with PNF, coagulation function and biochemical parameters are helpful to indicate the need for retransplantation. Severe preservation injury is characterized by cholestasis with rising bilirubin, alkaline phosphatase (AP), and gamma-glutamyl transpeptidase (GGT) levels that peak at the 10th day posttransplantation. We hypothesized that persistence of abnormalities of these cholestatic parameters beyond day 10 after transplantation may predict subsequent graft loss in patients with IPF.