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Serum Factor V Is a Continuous Biomarker of Graft Dysfunction and a Predictor of Graft Loss After Liver Transplantation

Gorgen, Andre, MD1,2; Prediger, Carolina3; Prediger, João E.3; Chedid, Marcio F., MD, PhD1,3; Backes, Ariane N., MD, PhD3; de Araujo, Alexandre, MD3; Grezzana-Filho, Tomaz J.M., MD, PhD3; Leipnitz, Ian, MD3; Chedid, Aljamir D., MD3; Alvares-da-Silva, Mario R., MD, PhD3; Sapisochin, Gonzalo, MD, PhD2; Kruel, Cleber R.P., MD, PhD1,3

doi: 10.1097/TP.0000000000002429
Original Clinical Science—Liver
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Background. Factor V has never been compared to a validated early allograft dysfunction (EAD) definition. We aimed to assess factor V as a biomarker of EAD and a predictor of graft loss after liver transplantation (LT).

Methods. We retrospectively assessed the serum factor V levels on postoperative day 1 after LT. Patients were divided according to their factor V levels into the ≤36.1 U/mL and > 36.1 U/mL groups. The primary outcome was graft loss within 1, 3, and 6 months. The secondary outcome was EAD, as defined by Olthoff et al. Predictors of outcomes were identified by multivariable logistic regression.

Results. Two hundred twenty-seven patients were included in the study: 74 with factor V of 36.1 U/mL or less and 153 with factor V >36.1 U/mL. EAD was diagnosed in 41 (55.4%) of 74 patients with factor V of 36.1 U/mL or less and in 20/153 (13.1%) patients with factor V >36.1 U/mL (P < 0.001). According to the multivariable regression model, factor V was a continuous marker of EAD (odds ratio [OR], 0.96; 95% confidence interval [CI], 0.94-0.98 per U/mL). Among the study groups, the 1-, 3-, and 6-month graft survival rates were 82%, 74%, and 74%, respectively, for patients with factor V of 36.1 U/mL or less and 98%, 95%, and 95%, respectively, for patients with factor V >36.1 U/mL (P = 0.001). Factor V was a continuous predictor for 3- and 6-month graft losses (OR, 0.96; 95% CI, 0.94-0.99 and OR, 0.97; 95% CI, 0.94-0.99 per U/mL), whereas EAD was not significant when adjusted for factor V.

Conclusion. Factor V is an early marker for EAD and is a continuous predictor of short-term graft loss after LT.

1 Postgraduate Program, Surgical Sciences, Medical School, Federal University of Federal do Rio Grande do Sul, Porto Alegre, Brazil.

2 Multi-Organ Transplant Program, General Surgery Department, University Health Network, Toronto General Hospital, University of Toronto, Toronto, Canada.

3 Liver Transplant Program, Hospital de Clinicas de Porto Alegre, Federal University of Rio Grande do Sul, Porto Alegre, Brazil.

Received 6 April 2018. Revision received 9 August 2018.

Accepted 14 August 2018.

The authors declared no funding or conflicts of interest.

A.G. has contributed to the study’s concept, design, data collection, data analysis, interpretation, and article writing. C.P. and J.E.P. have contributed to the data collection and approved the article’s final version. M.F.C., A.N.B., A.A., T.J.M.G., I.L., A.D.C., and M.R.A.S. have all contributed to the data interpretation and critical appraisal, and they also approved the article’s final version. G.S. and C.R.P.K. have contributed to the study’s concept, design, data interpretation, and article writing. All authors have approved the manuscript’s final version.

Supplemental digital content (SDC) is available for this article. Direct URL citations appear in the printed text, and links to the digital files are provided in the HTML text of this article on the journal’s Web site (www.transplantjournal.com).

Correspondence: Cleber Rosito Pinto Kruel, MD, PhD, Liver Transplant Program, Hospital de Clinical de Porto Alegre 2350 Ramiro Barcelos St, Office 745 Porto Alegre, Brazil 90035–903. (crkruel@hcpa.edu.br).

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