Elevated alanine aminotransferase (ALT) in the deceased donor: Impact on early post-transplant liver allograft function

Richard S. Mangus, Jonathan A. Fridell, Chandrashekhar A. Kubal, Jason P. Davis, A. Joseph Tector

Research output: Contribution to journalArticle

11 Citations (Scopus)

Abstract

Background & Aims: Serum alanine aminotransferase (ALT) levels are frequently elevated with liver injury and such elevations are common in deceased organ donors. The impact of this injury on early liver allograft function has not been well described. This study analyses the immediate function and 1-year graft and patient survival for liver allografts stratified by peak serum ALT levels in the deceased donor. Methods: The on-site organ procurement records for 1348 consecutive deceased liver donors were reviewed (2001-2011). Serum ALT was categorized into three study groups: normal/mild elevation, 0-499 μ/L; moderate elevation, 500-999 μ/L (>10× upper limit of normal) and severe elevation, ≥1000 μ/L (>20× upper limit of normal). Outcomes included early graft function and graft loss, and 1-year graft and patient survival. Results: Distribution of subjects included: normal/mild, 1259 (93%); moderate, 34 (3%) and severe, 55 (4%). Risk of 30-day graft loss for the three study groups was: 72 (6%), 3 (9%) and 3 (6%) (P = 0.74). Graft and patient survival at 1 year for the three groups was: normal/mild, 1031 (87%), 1048 (88%); moderate, 31 (91%), 31 (91%) and severe, 43 (88%), 44 (90%) (P = 0.71, 0.79). Cox proportional hazards modelling of survival while controlling for donor age and recipient model for end-stage liver disease score (MELD) demonstrates no statistically significant difference among the three study groups. Conclusions: This study demonstrates clinical equivalence in early graft function and 1-year graft and patient survival for donor livers with varying peak levels of serum ALT. These donor allografts may, therefore, be utilized successfully.

Original languageEnglish (US)
Pages (from-to)524-531
Number of pages8
JournalLiver International
Volume35
Issue number2
DOIs
StatePublished - Feb 1 2015

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Alanine Transaminase
Allografts
Tissue Donors
Graft Survival
Transplants
Liver
Serum
End Stage Liver Disease
Tissue and Organ Procurement
Wounds and Injuries
Survival

Keywords

  • Alanine aminotransferase (ALT)
  • Extended criteria donors
  • Orthotopic liver transplant
  • Outcomes

ASJC Scopus subject areas

  • Hepatology

Cite this

Elevated alanine aminotransferase (ALT) in the deceased donor : Impact on early post-transplant liver allograft function. / Mangus, Richard S.; Fridell, Jonathan A.; Kubal, Chandrashekhar A.; Davis, Jason P.; Joseph Tector, A.

In: Liver International, Vol. 35, No. 2, 01.02.2015, p. 524-531.

Research output: Contribution to journalArticle

Mangus, Richard S. ; Fridell, Jonathan A. ; Kubal, Chandrashekhar A. ; Davis, Jason P. ; Joseph Tector, A. / Elevated alanine aminotransferase (ALT) in the deceased donor : Impact on early post-transplant liver allograft function. In: Liver International. 2015 ; Vol. 35, No. 2. pp. 524-531.
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abstract = "Background & Aims: Serum alanine aminotransferase (ALT) levels are frequently elevated with liver injury and such elevations are common in deceased organ donors. The impact of this injury on early liver allograft function has not been well described. This study analyses the immediate function and 1-year graft and patient survival for liver allografts stratified by peak serum ALT levels in the deceased donor. Methods: The on-site organ procurement records for 1348 consecutive deceased liver donors were reviewed (2001-2011). Serum ALT was categorized into three study groups: normal/mild elevation, 0-499 μ/L; moderate elevation, 500-999 μ/L (>10× upper limit of normal) and severe elevation, ≥1000 μ/L (>20× upper limit of normal). Outcomes included early graft function and graft loss, and 1-year graft and patient survival. Results: Distribution of subjects included: normal/mild, 1259 (93{\%}); moderate, 34 (3{\%}) and severe, 55 (4{\%}). Risk of 30-day graft loss for the three study groups was: 72 (6{\%}), 3 (9{\%}) and 3 (6{\%}) (P = 0.74). Graft and patient survival at 1 year for the three groups was: normal/mild, 1031 (87{\%}), 1048 (88{\%}); moderate, 31 (91{\%}), 31 (91{\%}) and severe, 43 (88{\%}), 44 (90{\%}) (P = 0.71, 0.79). Cox proportional hazards modelling of survival while controlling for donor age and recipient model for end-stage liver disease score (MELD) demonstrates no statistically significant difference among the three study groups. Conclusions: This study demonstrates clinical equivalence in early graft function and 1-year graft and patient survival for donor livers with varying peak levels of serum ALT. These donor allografts may, therefore, be utilized successfully.",
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T2 - Impact on early post-transplant liver allograft function

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AU - Fridell, Jonathan A.

AU - Kubal, Chandrashekhar A.

AU - Davis, Jason P.

AU - Joseph Tector, A.

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N2 - Background & Aims: Serum alanine aminotransferase (ALT) levels are frequently elevated with liver injury and such elevations are common in deceased organ donors. The impact of this injury on early liver allograft function has not been well described. This study analyses the immediate function and 1-year graft and patient survival for liver allografts stratified by peak serum ALT levels in the deceased donor. Methods: The on-site organ procurement records for 1348 consecutive deceased liver donors were reviewed (2001-2011). Serum ALT was categorized into three study groups: normal/mild elevation, 0-499 μ/L; moderate elevation, 500-999 μ/L (>10× upper limit of normal) and severe elevation, ≥1000 μ/L (>20× upper limit of normal). Outcomes included early graft function and graft loss, and 1-year graft and patient survival. Results: Distribution of subjects included: normal/mild, 1259 (93%); moderate, 34 (3%) and severe, 55 (4%). Risk of 30-day graft loss for the three study groups was: 72 (6%), 3 (9%) and 3 (6%) (P = 0.74). Graft and patient survival at 1 year for the three groups was: normal/mild, 1031 (87%), 1048 (88%); moderate, 31 (91%), 31 (91%) and severe, 43 (88%), 44 (90%) (P = 0.71, 0.79). Cox proportional hazards modelling of survival while controlling for donor age and recipient model for end-stage liver disease score (MELD) demonstrates no statistically significant difference among the three study groups. Conclusions: This study demonstrates clinical equivalence in early graft function and 1-year graft and patient survival for donor livers with varying peak levels of serum ALT. These donor allografts may, therefore, be utilized successfully.

AB - Background & Aims: Serum alanine aminotransferase (ALT) levels are frequently elevated with liver injury and such elevations are common in deceased organ donors. The impact of this injury on early liver allograft function has not been well described. This study analyses the immediate function and 1-year graft and patient survival for liver allografts stratified by peak serum ALT levels in the deceased donor. Methods: The on-site organ procurement records for 1348 consecutive deceased liver donors were reviewed (2001-2011). Serum ALT was categorized into three study groups: normal/mild elevation, 0-499 μ/L; moderate elevation, 500-999 μ/L (>10× upper limit of normal) and severe elevation, ≥1000 μ/L (>20× upper limit of normal). Outcomes included early graft function and graft loss, and 1-year graft and patient survival. Results: Distribution of subjects included: normal/mild, 1259 (93%); moderate, 34 (3%) and severe, 55 (4%). Risk of 30-day graft loss for the three study groups was: 72 (6%), 3 (9%) and 3 (6%) (P = 0.74). Graft and patient survival at 1 year for the three groups was: normal/mild, 1031 (87%), 1048 (88%); moderate, 31 (91%), 31 (91%) and severe, 43 (88%), 44 (90%) (P = 0.71, 0.79). Cox proportional hazards modelling of survival while controlling for donor age and recipient model for end-stage liver disease score (MELD) demonstrates no statistically significant difference among the three study groups. Conclusions: This study demonstrates clinical equivalence in early graft function and 1-year graft and patient survival for donor livers with varying peak levels of serum ALT. These donor allografts may, therefore, be utilized successfully.

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KW - Extended criteria donors

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KW - Outcomes

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