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

ABSTRACT 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 This retrospective study enrolled 360 patients who performed pLT (living-donor liver transplantation (LDLT)=299, deceased-donor liver transplantation (DDLT)=61) between April 2017 and September 2024. The severity of EAD was graded using the Liver Graft Assessment Following Transplantation (L-GrAFT 7 ) risk score. Results The incidence of binary EAD in pLT was 34.2%. The area under the receiver operating characteristic curve of EAD, Model for Early Allograft Function (MEAF) score, and L-GrAFT 7 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