Intraoperative histological ischemia–reperfusion injury assessment but not clinical early allograft dysfunction predicts graft loss only in HCV positive recipients submitted to liver transplant

Introduction: Both ischemia–reperfusion injury (IRI) at operation and clinically assessed early allograft dysfunction during the first post-operative week (EAD) affect graft survival after liver transplantation (LT). Aim: The aim of our study was to evaluate the impact of IRI and EAD on graft loss, according to recipient HCV status. Materials and methods: We retrospectively analyzed 128 cirrhotic patients consecutively submitted to primary deceased-donor LT at our Center (November 2003–July 2011), with protocol coupled liver graft pre-ischemia and 1 h post-reperfusion biopsies. Several recipient, donor and graft variables, including pre-ischemia steatosis, were prospectively collected. IRI was categorized as mild-moderate or severe. Results: Median recipient and donor age were 54 (18–71) and 48 (9–81) years, respectively. Median graft follow-up was 47 months, median AST and ALT peak during the first post-operative week were 982 UI/ml and 912 UI/ml, respectively. Fifty-three (41%) recipients were serum HCV-RNA positive (HCV+). At multivariate Cox regression analyses: (a) severe IRI independently predicted graft loss only in HCV+ (HR 3.422, 95% CI 1.268–9.231; p = 0.015), but not in HCV− (HR 0.867, 95% CI 0.187–4.015; p = 0.885) recipients; (b) the occurrence of EAD independently predicted graft loss in HCV− (HR 2.982, 95% CI 1.072–8.289; p = 0.036), but not in HCV+ (HR 1.516, 95% CI 0.589–3.900; p = 0.388) recipients. Conclusions: IRI but not EAD predicts graft loss in HCV+ recipients, while the opposite is true for HCV− recipients. Post-reperfusion biopsy should be performed in HCV+ recipients.