Can elastography predict early allograft dysfunction or loss after liver transplantation? A prospective study of diagnostic accuracy

Abstract

Introduction: The imbalance between the demand for liver transplants and the shortage of donors can be addressed by expanding the donor pool, including using extended criteria donors. This strategy may reduce waiting time and list mortality but can increase poor graft function rates, affecting short-term outcomes. Tools to predict and diagnose Early Allograft Dysfunction (EAD) are crucial. Elastography for Liver Stiffness Measurement (LSM) may predict EAD and graft loss early post-transplant. Methods: In this prospective observational study, the authors assessed the diagnostic accuracy of elastography for predicting EAD or loss in liver transplant recipients admitted to the ICU of Hospital das Clínicas, Universidade de São Paulo, from 2016 to 2018. Patients underwent daily LSM from ICU admission to day 7 post-transplant. EAD was defined by Olthoff et al.’s criteria, and allograft loss was defined by the need for retransplantation or death within 180 days. Results: EAD developed in 27 patients (44.3%). The median LSM was 2.12 m/s (IQR 1.87–2.67 m/s) for the EAD group and 1.70 m/s (IQR 1.55–1.90 m/s) for the non-EAD group. For predicting EAD, elastography on day 1 had a c-statistic of 0.83, sensitivity 41%, specificity 97%, and accuracy 83% at a cutoff of 2.39 m/s. For predicting early allograft loss, the c-statistic was 0.93, with a sensitivity 76 %, specificity 100%, and accuracy 93% at a cutoff of 2.25 m/s on day 1. Conclusion: Elastography demonstrated robust performance in predicting EAD and early graft loss post transplant, outperforming traditional prognostic scores. Further multicenter studies are needed to confirm these findings.