Perioperative Dextran-40 Infusion and Early Allograft Outcomes After Adult Liver Transplantation: An Overlap-Weighted Cohort Study

INTRODUCTION: Dextran-40 has rheological and antithrombotic effects that could modulate early allograft injury, but contemporary evidence in adults is limited. We evaluated whether early postoperative dextran-40 use was associated with improved graft outcomes. METHODS: In this single-center retrospective cohort, we studied 900 adult liver transplant recipients (2009-2023) using a 48-h landmark to reduce immortal-time bias; 883 patients alive with their primary graft at 48 h formed the analytic cohort. Early exposure was defined as starting dextran-40 within 48 h after transplantation versus later or no dextran. Confounding was addressed with propensity score overlap weighting. Primary outcomes were primary nonfunction, early allograft dysfunction, and 30-day graft loss. RESULTS: In the overlap-weighted analyses, early dextran-40 was associated with lower 30-day graft loss (2.0% versus 7.6%; risk difference -5.6 percentage points, 95% confidence interval -10.5 to -0.7). Rates of primary nonfunction, early allograft dysfunction, mortality, thrombotic events, acute kidney injury, and reoperation for bleeding did not differ meaningfully between groups. CONCLUSIONS: In this contemporary cohort, early dextran-40 administration was associated with better short-term graft survival without evidence of safety concerns. These observational findings warrant confirmation in prospective multicenter trials.