Early increase in γ-GT and low bilirubin predict favourable outcome after orthotopic liver transplantation

Aims: Graft failure and patient death are still frequent events after liver transplantation, but early prediction of prognosis remains difficult. The aim of the present study was to determine if standard laboratory parameters measured within the first week after transplantation can predict prognosis.

Patients and Methods: Folders of 331 consecutive patients undergoing liver transplantation at Heidelberg University were reviewed and values for standard laboratory parameters recorded. Patients were grouped according to the time until either graft loss or death (group 1: <30 days; group 2: 31–90 days; group 3: >91 days). Mann-Whitney test was used for univariate analysis and a Cox-regression model was used for multivariate analysis.

Results: Peak values for both AST and ALT were significantly lower in group 3 (1867±110 U/L and 1252±67 U/L) than in group 1 (4578±698 U/L and 2308±257 U/L) or 2 (2772±512 U/L and 1560±275 U/L). The time to reach the peak value for AST and ALT was significantly shorter in group (3) than in group (1) (8.1±1.5h vs. 21.4±4.4h and 16.5±1.2h vs. 26.1±3.2h, resp.) and shorter than in group (2) (13.9±3.7h and 15.8±3.6h). Bilirubin between day 2–7 was significantly lower and γ-GT between day 3–7 significantly higher in group (3) compared to groups (1) and (2). In multivariate analysis, high AST peak and late AST peak were confirmed as independent predictors of death or graft loss within 90 days. Importantly, an early increase in γ-GT and low bilirubin were found as independent predictors for favourable outcome in multivariate analysis.

Conclusion: Easily available standard laboratory parameters measured within the first days after liver transplantation can predict outcome. Unexpectedly, a disproportionate elevation of γ-GT and low bilirubin predict graft and patient survival for more than 90 days.