The impact of early allograft dysfunction severity on graft and recipient outcomes in pediatric liver transplantation

INTRODUCTION AND OBJECTIVES: Early allograft dysfunction (EAD) substantially compromises graft and recipient outcomes; the clinical consequences of EAD vary according to severity. Research focusing on EAD in pediatric liver transplantation (pLT) remains notably limited. This study sought to validate the EAD severity grading models in pLT and assess the impact of varying severity grades of EAD on both graft and recipient outcomes. PATIENTS AND METHODS: ) risk score. RESULTS: risk score for predicting graft loss within 90-day post-transplant were 0.84, 0.97, and 0.96 in the LDLT cohort; and 0.79, 0.78, and 0.95 in the DDLT cohort. Significant differences were observed among the low-, moderate-, and high-risk groups in the LDLT cohort regarding ventilator support time, ICU stay time, length of hospitalization, death in hospital, early complications (including hepatic artery thrombosis, portal vein thrombosis, hepatic vein/inferior vena cava stenosis/thrombosis, and biliary complications), and late complications (including hepatic artery thrombosis, portal vein stenosis/thrombosis and hepatic vein/inferior vena cava stenosis). In the DDLT cohort, significant differences were found among the three groups in terms of ICU stay time, death in hospital, early complications (including intra-abdominal bleeding and biliary complications), and late complications (hepatic vein/inferior vena cava stenosis) (p<0.05). The log-rank test revealed statistically significant differences in graft and recipient survival among the three groups within 90-day, 180-day, and 1-year in both the LDLT and DDLT cohorts (p<0.05), with this significant difference also observed throughout follow-up period in the DDLT cohort (p<0.05). CONCLUSIONS: risk score effectively predict early graft loss following pLT, with high-risk EAD markedly compromising both short- and long-term graft and recipient outcomes.