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Invited Commentary
October 28, 2020

Predicting Early Hepatic Graft Failure—The Quest Continues

Author Affiliations
  • 1Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California
JAMA Surg. 2020;155(12):e204593. doi:10.1001/jamasurg.2020.4593

Beginning with the pioneering experimental liver transplants by Vittorio Staudacher1 and eventually the successful human liver transplant by Thomas Starzl,2 the remarkable advances in liver transplant have made it a highly durable, live-saving, and quality of life–restoring operation. This success has created a tremendous demand for organs to save the lives of thousands of patients annually. A record 8896 liver transplants were performed in the United States in 2019, an increase driven largely by more aggressive use of marginal organs. Of these transplants, 22% of the recipients were older than 65 years, a 100% increase from just 10 years ago, making it the largest increase of any age group.3 This aggressive use of donor organs coupled with a higher-acuity recipient population presents a constant challenge in managing outcomes, reducing futility, and replacing a failing graft in a timely manner to avoid further recipient compromise. To that end, numerous studies have strived to identify predictors of early graft dysfunction and ultimately failure.

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