Lazzarotto-da-Silva G, Chaves BM, Feier FH, Rodrigues PD, Grezzana-Filho TJM, de Araujo A, Alvares-da-Silva MR, Marchiori RC, Chedid MF, Kruel CRP. Serum factor V and arterial lactate levels predict graft survival in liver transplant recipients with aminotransferase above five thousand. World J Transplant 2025; 15(4): 107461 [DOI: 10.5500/wjt.v15.i4.107461]
Corresponding Author of This Article
Marcio Fernandes Chedid, MD, PhD, Professor, Liver Transplant and Hepatobiliary Surgery Unit, Hospital de Clínicas de Porto Alegre, Rua Ramiro Barcelos 2350, Porto Alegre 90035-007, Rio Grande do Sul, Brazil. mchedid@hcpa.edu.br
Research Domain of This Article
Transplantation
Article-Type of This Article
Retrospective Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Transplant. Dec 18, 2025; 15(4): 107461 Published online Dec 18, 2025. doi: 10.5500/wjt.v15.i4.107461
Serum factor V and arterial lactate levels predict graft survival in liver transplant recipients with aminotransferase above five thousand
Gabriel Lazzarotto-da-Silva, Bruno Marches Chaves, Flávia Heinz Feier, Pablo Duarte Rodrigues, Tomaz Jesus Maria Grezzana-Filho, Alexandre de Araujo, Mario Reis Alvares-da-Silva, Roberta Cabral Marchiori, Marcio Fernandes Chedid, Cleber Rosito Pinto Kruel
Gabriel Lazzarotto-da-Silva, Flávia Heinz Feier, Pablo Duarte Rodrigues, Tomaz Jesus Maria Grezzana-Filho, Marcio Fernandes Chedid, Cleber Rosito Pinto Kruel, Liver Transplant and Hepatobiliary Surgery Unit, Hospital de Clínicas de Porto Alegre, Porto Alegre 90035-007, Rio Grande do Sul, Brazil
Bruno Marches Chaves, Department of Digestive Surgery, Hospital de Clínicas de Porto Alegre, Porto Alegre 90035-903, Rio Grande do Sul, Brazil
Alexandre de Araujo, Roberta Cabral Marchiori, Department of Gastroenterology and Hepatology, Hospital de Clínicas de Porto Alegre, Porto Alegre 90035-007, Rio Grande do Sul, Brazil
Mario Reis Alvares-da-Silva, Division of Gastroenterology, Hospital de Clínicas de Porto Alegre, Porto Alegre 90035-007, Rio Grande do Sul, Brazil
Author contributions: Lazzarotto-da-Silva G and Chedid MF participated in the research design, data collection, data analysis, and writing of the manuscript; Rodrigues PD, Feier FH, Grezzana-Filho TJM, de Araujo A, Alvares-da-Silva MR, Marchiori RC, and Kruel CRP participated in the research design and revision of the final version of the manuscript; all of the authors read and approved the final version of the manuscript to be published.
Supported by Financiamento e Incentivo à Pesquisa of Hospital de Clínicas de Porto Alegre, No. 170271.
Institutional review board statement: This study complies with ethical standards and was approved by the Hospital de Clínicas de Porto Alegre Institutional Review Board.
Informed consent statement: Informed consent was waived by the ethics committee because this was an observational retrospective study.
Conflict-of-interest statement: All authors declare no conflict of interest.
Data sharing statement: No additional data are available.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Marcio Fernandes Chedid, MD, PhD, Professor, Liver Transplant and Hepatobiliary Surgery Unit, Hospital de Clínicas de Porto Alegre, Rua Ramiro Barcelos 2350, Porto Alegre 90035-007, Rio Grande do Sul, Brazil. mchedid@hcpa.edu.br
Received: March 24, 2025 Revised: April 13, 2025 Accepted: May 21, 2025 Published online: December 18, 2025 Processing time: 240 Days and 11 Hours
Abstract
BACKGROUND
Liver transplantation (LT) is the preferred treatment for end-stage liver diseases. Early allograft failure (EAF) can result in death or retransplantation. One of the key factors predicting EAF is the degree of graft injury, which is typically assessed by elevated alanine aminotransferase (ALT) and aspartate aminotransferase (AST) levels. Aminotransferase levels exceeding 5000 U/L within 48 hours of LT are indicative of poor short-term graft survival.
AIM
To investigate outcomes in liver transplant recipients with peak aminotransferase levels exceeding 5000 U/L and to identify predictors of EAF.
METHODS
Adult patients who underwent LT from a deceased (brain-dead) donor between 2011 and 2024 at Hospital de Clínicas de Porto Alegre were screened. Patients with peak AST or ALT levels > 5000 U/L post-LT were included, excluding those with vascular thrombosis. EAF was defined as death or re-transplantation within 90 days. A receiver operating characteristic curve were generated for each EAF predictor to determine the area under the curve (AUC). Sensitivity, specificity, negative predictive value, and positive predictive value were calculated for each predictor’s best cutoff, as defined by the Youden Index. Survival curves were plotted using the Kaplan-Meier method.
RESULTS
Between 2011 and 2024, 341 patients underwent LT. Of these, 29 (8.5%) patients had AST and/or ALT levels exceeding 5000 U/L within the first 48 hours post-LT. Four patients were excluded due to vascular thrombosis, resulting in a study cohort of 25 patients. EAF were also observed in 11 patients. One-year and five-year graft survival rates were 51.7% and 42.6%, respectively. For patients without EAF, one-year and five-year graft survivals were 92.3% and 76.2%, respectively. The key predictors of EAF included serum factor V and arterial lactate levels on postoperative day (POD) 1, with AUCs of 0.936 and 0.919, respectively. The optimal cutoff for EAF prediction were 26.2% for serum factor V and 9 mmol/L for arterial lactate.
CONCLUSION
Aminotransferase levels > 5000 U/L were associated with high EAF risk. However, favorable graft function indicators on POD 1 were associated with long-term survival comparable to that of general LT recipients. Serum factor V and arterial lactate levels emerged as valuable prognostic markers.
Core Tip: Among 341 liver transplant recipients, 25 had an aminotransferase level > 5000 U/L. Early allograft failure (death or re-transplantation within 90 days) occurred in 11 patients. One-year and five-year graft survival rates were 51.7% and 42.6%, respectively. However, approximately 50% of these patients withstood initial graft injury and had a satisfactory long-term prognosis. Therefore, early identification of patients who will recover graft function or undergo graft loss is paramount. Serum factor V and arterial lactate levels can aid in deciding whether to relist patients to retransplantation early in the postoperative period.
