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P-12.66 Late liver allograft dysfunction: Frequency, types, risk factors

Yulia Malinovskaya, Russian Federation

researŅh fellow, hepatologist


Late liver allograft dysfunction: Frequency, types, risk factors

Yulia Malinovskaya1, Ksenia Kokina1, Yan Moysyuk1.

1Transplantology, MONIKI, Moscow, Russian Federation

Proper liver transplant function depends on diversity of characteristics: patient, donor, surgery and posttransplant. In contrast to early allograft dysfunction (EAD) risks it is still not well established what exactly determines good liver transplant condition on long term.
Aim: to determine frequency, composition and risk factors of late liver allograft dysfunction (LAD)
Materials and methods: The data of 110 liver transplants followed-up in Moscow Regional Scientific and Research Institute (MONIKI) was included. Inclusion criteria: age more than 18 years, inpatient survival. The criteria of LAD were: abnormal aminotransferase level (AST and ALT), GGT, alkaline phosphatase or bilirubin, low albumin or prothrombin which fails to normalize or any symptoms of liver cirrhosis (esophageal varices, encephalopathy, ascites).
Results: 5 graft were lost due to biliary (3), unknown etiology and patient death. LAD from discharge to 3, 6, 12 month, 3, 5 and 10 years posttransplant was diagnosed in 36%, 28%, 30%, 37%, 28%, 33% of cases respectively. The most common etiology was unknown (17-39% between all reasons of LAD). Viral infection incidence increased from 23% to 52% between 1st and 5th year due to hepatitis C recurrence, but diminished to 0% on 10 year with antivirals . Biliary complications were determined in 9% to 40% of LAD. Rejection (13-17% of LAD) and autoimmune hepatitis (4 cases – 3%) also took place.
Cold ischemia time and EAD seem not to affect LAD incidence (p>0,05). Roux-en-Y anastomosis increased proportion of biliary complication (p<0,05, RR (95% CI, 1,7-12,6)=4.643), but didn`t impact on overall LAD count. Frequency of rejection was higher in autoimmune and cholestatic patients  (p<0,05, RR  (95%  CI, 1,7-20,8) =5,935), despite of triple-drug immunosuppressive regimen.
Conclusion: In our center late allograft dysfunction is observed in 1/3 of patients. Donor factors are not significant for LAD, but patient and surgical are.


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