Early allograft dysfunction after liver transplant: approach to diagnosis and management

Purpose of review Early allograft dysfunction (EAD) is one of the most challenging complications following liver transplantation. With the shortage of deceased donor organs, living donor liver transplants are increasing, especially in the Asia Pacific region. With continuously evolving practices and literature, an overview of prevailing EAD definitions (including subtle differences between deceased and living donor-related EAD), donor-specific and recipient-specific risk factors, predictive scoring models, status of biomarkers, and current management practices, has become imperative. Recent findings Post living donor liver transplantation (LDLT), EAD is a distinct clinicopathological entity from post deceased donor liver transplantation (DDLT) and is primarily characterized by functional graft insufficiency rather than ischaemia–reperfusion injury (IRI)-mediated necroinflammation of DDLT. A novel preoperative risk score (e-GLR) demonstrates excellent discriminative ability for predicting early graft loss secondary to graft dysfunction in LDLT. In a mixed DDLT–LDLT cohort, acute liver failure (ALF), donor age, and warm ischaemic time (WIT) are the principal determinants of EAD. Summary There is also need for individualized risk stratification in EAD, including donor quality, graft volume, recipient disease severity, and intraoperative parameters. The increasing use of marginal grafts owing to organ scarcity has led to increase in its incidence. Preoperative scoring tools such as early graft loss score (e-GLR) can help guide donor–recipient matching and counsel families before live-donor hepatectomy.