Abstract
<title>Abstract</title> <p>Objective This study aimed to analyze the risk factors associated with early allograft dysfunction (EAD) following orthotopic liver transplantation (OLT) and ex vivo liver resection combined with autologous liver transplantation (ELRA), and to develop predictive models with the ultimate goal of optimizing clinical pathways and improving patient outcomes. Methods This retrospective study analyzed patients who underwent LT in the ICU of between January 2013 and April 2024. Patients were categorized based on EAD occurrence and surgical procedure. Comparative analyses were conducted across the groups to identify the independent risk factors for EAD, which were subsequently used to develop a predictive model. Results In OLT recipients, postoperative day 0 (POD0) procalcitonin, POD0 interleukin-6 (IL-6), and POD0 prothrombin time were identified as the primary risk factors for EAD. In ELRA recipients, intraoperative packed red blood cell transfusion volume, POD0 international normalized ratio (INR), and postoperative epinephrine use were significantly associated with EAD development. Based on these findings, separate nomograms were constructed for each surgical cohort. Both nomogram models demonstrated satisfactory goodness-of-fit, and the decision curve analysis (DCA) together with the clinical impact curve (CIC) confirmed their clinical utility, thereby enhancing the early identification of EAD. Conclusions This study suggests that the pathogenic mechanisms underlying EAD differ according to the type of liver transplantation performed. In OLT, EAD appears to be predominantly driven by inflammatory-immune cascades, whereas in ELRA, it is primarily governed by perioperative hemodynamic and circulatory instability. The category-specific predictive models developed in this study demonstrated superior accuracy in identifying high-risk patients along distinct pathological pathways. Accordingly, differentiated clinical management strategies are warranted: OLT recipients may benefit from early and targeted anti-inflammatory intervention, while ELRA patients require meticulous monitoring and optimization of volume status and hemodynamic parameters.</p>