Sohail KHAN, Melanie VUGELMAN, Louis BORSELLINO, Olzhas ZHORAYEV, Deric TORO, Giovanni FADDOUL, Katherine CONNORS, Meng-Hao LI, Naoru KOIZUMI, Jorge ORTIZ
Experimental and Clinical Transplantation - 2026;24(9):716-727
Objectives: Seven-day graft loss (first postoperative week graft failure or recipient death) has not been systematically characterized at a national scale in adult liver transplantation. We identified etiologies and independent predictors of 7-day graft loss, primary nonfunction, and 7-day posttransplant death in adult deceased donor liver transplant recipients. Materials and Methods: We retrospectively analyzed 54 646 adult deceased donor liver transplant recipients (Organ Procurement and Transplantation Network, 2015-2024) and evaluated etiologies and independent predictors of 7-day graft loss, primary nonfunction, and 7-day posttransplant death using multivariable logistic regression. Results: Among 1442 events of 7-day graft loss (2.6%), primary nonfunction predominated (43.6%), followed by graft thrombosis (10.3%) and infection (3.8%). Cardiovascular failure (42.6%) was the leading cause of 7-day death. Retransplant (odds ratio 3.72; P < .001), Status 1 (odds ratio 2.24; P < .001), donation after circulatory death (odds ratio 1.82; P < .001), dialysis dependence (odds ratio 1.79; P < .001), and Black recipient race (odds ratio 1.74; P < .001) independently predicted 7-day graft loss. Male recipient sex was protective (odds ratio 0.86; P = .01). Each additional hour of cold ischemia time increased 7-day graft loss odds by 10% (odds ratio 1.10; P < .001). The primary nonfunction model identified Hispanic (odds ratio 1.27; P = .03) and Asian (odds ratio 1.60; P = .02) recipient race as additional predictors, with 34% lower odds from 2020 onward (odds ratio 0.66; P < .001), coincident with acuity circle allocation and expanded machine perfusion adoption. The 7-day death model added recipient age >=60 years (odds ratio 1.58; P < .001) and elevated Model for End-Stage Liver Disease score (odds ratio 1.01; P = .003) as independent contributors. Conclusions: Every predictor is ascertainable before transplant, supporting risk stratification during organ offers, informed donor-recipient matching, and perioperative optimization to reduce early graft loss.
