Preoperative Risk Factors for Early Allograft Dysfunction Following Living Donor Liver Transplantation: A Case-Control Study

Background: Early allograft dysfunction (EAD) is a frequent early complication after liver transplantation and is linked to increased morbidity and mortality. This study aimed to identify preoperative factors associated with EAD in recipients of living donor liver transplantation (LDLT). Methods: This retrospective case-control study included two groups of Egyptian patients who underwent LDLT at the Ain Shams Center for Organ Transplantation (ASCOT) between January 2019 and December 2023. The case group included eighty cases that had EAD, while eighty cases in the control group had satisfactory outcomes. The preoperative risk factors—such as age, sex, smoking, non-steroidal anti-inflammatory drug (NSAID) use, and alcohol or substance abuse for both the recipient and his donor—and their effect on graft function post-LDLT were assessed, together with the recipient's Model for End-Stage Liver Disease (MELD) score, comorbidities (diabetes mellitus (DM), hypertension (HTN), and hypothyroidism), and recipient-donor sex matching. Results: Data analysis revealed significant differences in recipient age, MELD score, NSAID use, diabetes, recipient–donor sex mismatch, and donor alcohol history between the two groups. Multivariate analysis identified donor alcohol intake, high MELD score, and older recipient age as independent predictors for EAD. Conclusion: Donor alcohol use, high MELD scores, and older recipient age were independently associated with EAD after LDLT. Recognizing these preoperative risk factors may support better candidate selection and perioperative management to reduce the risk of graft dysfunction.