Lactate/platelet ratio after liver transplantation; A novel predictor for short-term graft failure
Takahashi K, Nagai S, Safwan M, Collins K, Rizzari M, Yoshida A, Ohkohchi N, and Abouljoud M. Lactate/platelet ratio after liver transplantation; A novel predictor for short-term graft failure. Am J Transplant 2018;18(Suppl 4):557.
Am J Transplant
Background; Recently, platelet count and lactate level after liver transplantation (LT) have been both separately reported as predictors of graft failure. In this study, we discovered a novel combination of these two parameters, “lactate level immediately post-LT (mmol/L)/platelet count on postoperative day 5 (x 1,000/ uL) ratio (LPR)” to predict short-term graft failure. Method; We retrospectively reviewed 434 deceased donor LT between January 2008 and December 2014. Using ROC analysis, cutoff values of LPR immediately post-LT for 90-days graft survival were determined. Risk factors for graft failure at 90-days and 1-year post-LT were analyzed by Cox regression model. Further, risk factors for high LPR combined with early allograft dysfunction (EAD) were determined by logistic regression model. 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. Results;Cut-off value for LPR to predict 90-day graft loss was 0.12 with AUC of 0.80 (sensitivity 71% and specificity 79%). On multivariate analysis, reoperation within 30 days (HR =2.97, P =0.03), EAD (HR =5.80, P =0.003) and LPR >0.12 (HR =3.99, P =0.01) were independent risk factors for 90-days graft failure. Also, reoperation within 30 days (HR =2.15, P =0.02), EAD (HR =2.91, P =0.001), and LPR >0.12 (HR =2.41, P =0.01) were independent risk factors for 1-year graft failure. Scoring system using EAD (0 or 1) and high LPR (0 or 1) stratified 90 days and 1 year graft survival (P <0.001, [Figure 1]). Reoperation within 7 days (Odds ratio [OR] =7.24, P <0.001), liver donor risk index >1.70 (OR =2.92, P =0.02), and warm ischemia time >45 minutes (OR =2.26, P =0.04) were considered independent risk factors for EAD with high LPR (>0.12). Conclusions; Our results suggested that high LPR (>0.12) might be a reliable predictor for early graft failure after LT, especially combined with EAD. Further investigation is warranted to elucidate the clinical implication of LPR.