Are short‐term complications associated with poor allograft and patient survival after liver transplantation? A systematic review of the literature and expert panel recommendations

Abstract Background Maximizing patient and allograft survival after liver transplant (LT) is important from both a patient care and organ utilization perspective. Although individual studies have addressed the effects of short‐term post‐LT complications on a limited scale, there has not been a systematic review of the literature formally assessing the potential effects of early complications on long‐term outcomes. Objectives To identify whether short‐term complications after LT affect allograft and overall survival, to identify short‐term complications of particular clinical interest and significance, and to provide recommendations to improve post‐LT graft and patient survival. Data sources Ovid MEDLINE, Embase, Scopus, Google Scholar, and Cochrane Central. Methods A systematic review following PRISMA guidelines and recommendations using the GRADE approach derived from an international expert panel. Results The literature review and analysis provided show that short‐term complications have a large impact on allograft and patient survival after LT. The complications with the strongest effect on survival are acute kidney injury (AKI), biliary complications, and early allograft dysfunction (EAD). Conclusion This panel recommends taking measures to reduce the risk and incidence of short‐term complications post‐LT. Clinicians should pay particular attention to preventing or ameliorating AKI, biliary complications, and EAD (Quality of evidence; Moderate | Grade of Recommendation; Strong).