Model for Early Allograft Function is predictive of early graft loss in donation after circulatory death liver transplantation

Donation after circulatory death (DCD) liver transplantation is associated with higher rates of graft loss. In this paper, we explored whether the Model for Early Allograft Function (MEAF) predicted outcome in DCD liver transplantation. We performed a retrospective analysis of prospectively collected data from all adult DCD (Maastricht 3) livers transplanted in Cambridge and Edinburgh between 1st January 2011 and 30th June 2017, excluding those undergoing any form of machine perfusion. 187 DCD liver transplants were performed during the study period. DCD liver transplants with a lower MEAF score had a significantly better survival compared to those with a high MEAF score (Mantel-Cox p< 0.0001); this was largely due to early graft loss. Beyond 28 days post-transplant there were no significant long-term graft or patient survival differences irrespective of the grade of MEAF (Mantel Cox p=0.64 and p=0.43 respectively). The MEAF score correlated with the length of ICU (p=0.0011) and hospital stay (p=0.0007), but did not predict the requirement for retransplantation for ischaemic cholangiopathy (p=0.37) or readmission (p=0.74). In this study, a high MEAF score predicted early graft loss, but not the subsequent need for re-transplantation or late graft failure as a result of intrahepatic ischemic bile duct pathology.