Aim: To evaluate if any association existed between the extent of allograft necrosis in liver biopsy and patient survival. Methods: Sixty-nine patients who had 70 liver transplantations with allograft necrosis were included in the study. Correlations of necrosis, the Model for End-Stage Liver Disease (MELD) score, and allograft survival were analyzed. Results: Allograft failure rate within 1 month after index biopsy was worse in patients with a higher extent of necrosis (2.5%, 12.5%, 25%, and 40% in groups with allograft necrosis of 1-25%, 26-50%, 51-75%, and >75%, respectively). Adequate biopsy with more than 50% necrosis is associated with significant allograft failure (P < .001). The MELD scores did not always accurately predict fatality that was caused by massive necrosis. In the absence of substantial clinical changes, repetition of allograft biopsy within a short period of time did not provide additional value. Among patients with more than 75% allograft necrosis, one who received an immediate second transplantation survived and 3 out of 9 patients who had not received those deceased within 1 month. Conclusions: Allograft necrosis demonstrates strong predictive power in organ and patient survival. Additionally, biopsy-proven allograft necrosis unequivocally pinpoints ischemia as the direct cause of allograft failure, which facilitates clinical management. Immediate retransplantation is crucial for patients with substantial allograft necrosis.
|Original language||English (US)|
|State||Accepted/In press - 2020|
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