Background: Early allograft dysfunction (EAD) in liver transplantation (LT) is a useful intermediate outcome measure to predict graft loss or mortality. We sought to investigate the incidence of and reasons for EAD and its role in predicting graft loss and mortality after LT in a large volume LT program.

Methods: Retrospective review of primary LT between 2002-2013. All donor, recipient and perioperative data was obtained from chart review. EAD was defined by the presence of 1 or more of the following variables: (1) bilirubin ≥10 mg/dL on postoperative day 7, (2) INR ≥1.6 on postoperative day 7, and (3) an aminotransferase level (ALT or AST) ≥ 2000 IU mL within the first 7 post-operative days.

Results: In 1952 consecutive LT we found that 518 (26.5%) patients had EAD. 1 and 5 year survival for patients who did not have EAD vs. those who did were 94.7% vs. 85.1% and 78.8% vs. 65.2%, respectively (p <0.01). 1 and 5 year allograft survival for patients who did not have EAD vs. those who did were 91.4% vs. 78.6% and 74.8% vs. 57.2%, respectively (p <0.01). Multivariate analysis demonstrated significant association of development of EAD with recipient's ventilator status before LT (OR: 3.06; P <0.01), donor age (OR: 1.15; P <0.01), DCD donor (OR: 2.55; P <0.01), donor liver mass (OR: 1.07; P <0.01), allograft steatosis (OR: 2.52; P <0.01), CIT (OR: 1.08; P = 0.04), blood transfusion (OR: 1.02; P = 0.02), and operative time (OR: 1.14; P <0.001).

Conclusion: This is the largest LT cohort documenting effect of EAD in graft and patient survival. EAD is associated with inferior patients and allograft survival. Future efforts to prevent EAD should be the focus to increase outcomes after LT.

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