Transplantation Direct (Jun 2023)

Low C-reactive Protein and Urea Distinguish Primary Nonfunction From Early Allograft Dysfunction Within 48 Hours of Liver Transplantation

  • James M. Halle-Smith, MRCS,
  • Lewis Hall, BSc,
  • Angus Hann, MBBS, MRCS,
  • Asif Arshad, FFICM,
  • Matthew J. Armstrong, PhD, MRCP,
  • Mansoor N. Bangash, PhD, FFICM,
  • Nick Murphy, FFICM,
  • James Cuell, FRCA,
  • John L. Isaac, FRCA,
  • James Ferguson, MD, FRCPE,
  • Keith J. Roberts, PhD, FRCS,
  • Darius F. Mirza, MD, FRCS,
  • M. Thamara P. R. Perera, PhD, FRCS

DOI
https://doi.org/10.1097/TXD.0000000000001484
Journal volume & issue
Vol. 9, no. 6
p. e1484

Abstract

Read online

Background. Primary nonfunction (PNF) is a life-threatening complication of liver transplantation (LT), but in the early postoperative period, it can be difficult to differentiate from early allograft dysfunction (EAD). The aim of this study was to determine if serum biomarkers can distinguish PNF from EAD in the initial 48 h following LT. Materials and Methods. A retrospective study of adult patients that underwent LT between January 2010 and April 2020 was performed. Clinical parameters, absolute values and trends of C-reactive protein (CRP), blood urea, creatinine, liver function tests, platelets, and international normalized ratio in the initial 48 h after LT were compared between the EAD and PNF groups. Results. There were 1937 eligible LTs, with PNF and EAD occurring in 38 (2%) and 503 (26%) patients, respectively. A low serum CRP and urea were associated with PNF. CRP was able to differentiate between the PNF and EAD on postoperative day (POD)1 (20 versus 43 mg/L; P < 0.001) and POD2 (24 versus 77; P < 0.001). The area under the receiver operating characteristic curve (AUROC) of POD2 CRP was 0.770 (95% confidence interval [CI] 0.645-0.895). The urea value on POD2 (5.05 versus 9.0 mmol/L; P = 0.002) and trend of POD2:1 ratio (0.71 versus 1.32 mmol/L; P < 0.001) were significantly different between the groups. The AUROC of the change in urea from POD1 to 2 was 0.765 (95% CI 0.645-0.885). Aspartate transaminase was significantly different between the groups, with an AUROC of 0.884 (95% CI 0.753-1.00) on POD2. Discussion. The biochemical profile immediately following LT can distinguish PNF from EAD; CRP, urea, and aspartate transaminase are more effective than ALT and bilirubin in distinguishing PNF from EAD in the initial postoperative 48 h. Clinicians should consider the values of these markers when making treatment decisions.