*Purpose: Lactate is one of the most frequently used makers to understand real-time graft function after liver transplant (LT). This study aimed to investigate risk factors for early allograft dysfunction (EAD), focusing on perioperative lactate levels.

*Methods: We retrospectively reviewed 435 decease-donor LT between January 2008 and December 2014. EAD was defined as a peak values of aminotransferase >2000 IU/mL during the first week or an international normalized ratio ≥1.6 and/or bilirubin ≥10 mg/dL at day 7. Early lactate clearance was defined as reduction rate of lactate from the time after reperfusion to immediately after LT. The risk factors for EAD were analyzed by multivariate analyses, using logistic regression model.

*Results: EAD occurred in 127 cases (29.2%). EAD became independent risk factors for 90-day (Hazard ratio [HR] =11.7) and 1-year (HR =3.94) graft loss by multivariate analyses, using Cox regression model. A cut-off values for lactate level immediately post-LT and early lactate clearance predicting EAD were 3.35 mmol/L and 0.2 mmol/L/hour, respectively. On multivariate analysis, macrosteatosis >30% {Odds ratio (OR) =17.91}, reoperation within 7 days (OR =4.74), liver donor risk index >1.7 (OR =2.13), warm ischemia time> 60 minutes (OR =3.23), lactate level >3.35 mmol/L immediately post-LT (OR =2.51), and lactate clearance <0.2 mmol/L/hour (OR =2.56) were independent risk factors for EAD. Combination with high lactate level and delayed lactate clearance stratified 90-day and 1-year graft survival (p =0.001 and 0.003, respectively), but not in the long-term graft survival.

*Conclusions: Initial high lactate and delayed lactate clearance were predictors for EAD. Short-term graft survival can be clearly stratified by a combination of these two parameters.

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