Supplementary table S1. Summary of 8 patients who underwent ABO incompatible transplant.
S.
No.
Type of isoagglutinin titre
Isoagglutinin titre at the time of transplant
CD19 count at transplant
(%)
PE, Ads before
LT
Type of graft
GRSVR HPi EAD Rejection Pulse PE, Ads after LT
Early complications
90-day Mortality
1 Anti-A 1:2 0.06 No MRL 3.27 6.12 No No No No Bile duct
stricture, sepsis No
2 Anti-A 1:8 0.27 PE,
Ads LL 0.74 20.14 Yes Yes Yes No None No
3 Anti-A 1:2 0.1 PE MRL 1.59 8.54 No No No PE None No
4 Anti-A 1:8 0.05 PE MRL 1.07 14.05 Yes No No PE None No
5 Anti-A 1:1 0.38 No MRL 1.10 16.34 No No No No Sepsis Yes
6 Anti-B 1:2 0.36 No MRL 0.45 13.40 Yes No Yes No Bile duct
stricture No
7 Anti-A 1:4 0.04 PE MRL 1.97 7.12 No No No No None No
8 Anti-A 1:1 0.2 No MRL 0.58 20.66 Yes No No No None No
Ads, Immunoadsorption; EAD, early graft dysfunction; GRSVR, graft to recipient splenic volume ratio; HPi, hyper-perfusion index; LL, left lobe graft; MRL, modified right lobe graft; PE, plasma exchange
Supplementary table S2. Univariate ANOVA of factors identified on multivariate analysis (alpha < 0.005 after Bonferroni correction).
Variables F df P-value partial η
2Sarcopenia 4.023 1,85 0.048 0.045
Donor sex 10.584 1,85 0.007 0.111
Preoperative hemoglobin 3.706 1,85 0.058 0.042
Preoperative platelet count 0.510 1,85 0.477 0.006
Graft weight 1.464 1,85 0.230 0.017
Splenic volume 24.083 1,85 <0.001 0.221
GRWR 3.455 1,85 0.067 0.039
GRSVR 9.250 1,85 0.003 0.198
ΔP
post4.355 1,85 0.004 0.149
HPi 30.683 1,85 <0.001 0.265
ΔP
post, post-operative portal pressure gradient; GRSVR, graft to recipient splenic volume ratio; GRWR, graft to recipient weight ratio; HPi,
hyper-perfusion index.
Supplementary table S3. Postoperative outcomes in HPi groups determined by cut-offs of 9.97 (as for EAD) for test (n=96) and validation (n=39) cohorts.
Test 0.045 0.050 <0.001 0.001
Mean Platelet count, x103/mm3
Validation 0.039 0.130 0.193 <0.001
1.22±0.04
Test 0.003 <0.001
1.60±0.06 Mean INR
1.21±0.07
Validation 0.008 0.011
1.51±0.08
3.4±0.4
Test 0.003 <0.001
<0.001 0.001
Mean Bilirubin (total), ≥9.97 7.3±0.8
mg/dl 4.0±0.8
Validation 0.081 0.173 0.038 0.043
Cohort HPi POD3 p-value POD7 p-value POD10 p-value POD15 p-value
<9.97 52.1±4.4 78.3±6.1 138.0±10.0 224.4±20.7
≥9.97 35.1±7.4
<9.97 2.21±0.12
53.6±15.6 86.4±19.9 109.0±14.2
≥9.97 37.0±6.2 56.1±9.9 76.3±7.9 133.8±14.7
<9.97 68.5±13.4 119.9±37.8 116.7±12.8 242.1±27.2
≥9.97 2.71±0.10
<9.97 2.15±0.13
≥9.97 2.85±0.20
<9.97 3.3±0.4 2.1±0.3 1.5±0.4
5.8±0.7
<9.97 3.4±0.5 7.9±1.0 5.6±1.0
3.1±0.8 2.1±0.6
5.7±0.9
2.88±0.06
Test 0.378 0.944 0.346 0.004
2.88±0.06 Mean Albumin, gm/dl
2.89±0.08
Validation 0.245 0.102 0.006 0.083
2.70±0.08
2.1±0.2
Test 0.168 0.026 0.001 0.245
2.9±0.3 Mean drain output, L
2.3±0.4
Validation 0.365 0.378 0.001 0.009
≥9.97 1.8±0.3 2.8±0.3 3.0±0.2 1.7±0.3
EAD, early allograft dysfunction; HPi, hyper-perfusion index; INR, international normalized ratio; POD, post-operative day
.
≥9.97 4.8±0.6
<9.97 2.88±0.04
6.5±1.3 6.3±2.1
2.86±0.06 3.06±0.08
≥9.97 2.82±0.06
<9.97 2.97±0.10
2.78±0.07 2.71±0.08
2.94±0.09 2.90±0.09
≥9.97 2.81±0.09
<9.97 1.3±0.2
2.60±0.07 2.67±0.09
1.6±0.2 0.9±0.3
≥9.97 1.6±0.2
<9.97 1.4±0.3
2.6±0.3 1.3±0.2
1.7±0.3 0.6±0.3
Supplementary table S4: Details of seven patients who had within 90-day mortality in total study cohort.
Age Sex Etiology Decompensations and
complications
Child Score
MELD ABOi Type of graft
ΔPpre ΔPpost Splenic volume (cc)
GW (gm)
GRWR GRSVR (gm/cc)
HPi PNF EAD Post-op day of mortality
36 M NASH related CLD
HE, SBP, AKI, Ascites, PHTN, Sarcopenia
13 35 No RL with
Partial MHV
15 12 1010 535 0.97 0.53 22.7 No Yes 8
41 F Cryptogenic CLD Ascites, PHTN 10 23 No MRL 18 19 1255 724 0.94 0.42 32.9 No Yes 36
60 M
NASH related CLD, HCC
Ascites, PHTN 9 21 No MRL 30 20 1580 633 1.00 0.57 49.9 No Yes 39
41 M Ethanol related CLD
HE, AKI, PHTN 10 22 No MRL 33 22 1608 615 0.81 0.38 57.5 Yes Yes 9
44 M NASH related CLD
Pre-op PVT, HE, PHTN
10 17 Yes MRL 11 18 680 749 0.83 1.10 16.3 No No 19
56 M NASH related CLD
AKI, PHTN, Sarcopenia
9 22 No MRL 23 15 661 558 0.91 0.84 17.8 No Yes 9
73 F HCC, NASH related CLD
Pre-op PVT, PHTN
6 10 No MRL 10 12 652 472 0.89 0.72 16.6 Yes Yes 3
ΔPpre, pre-operative portal pressure gradient; ΔPpost, post-operative portal pressure gradient; ABOi, ABO incompatible; ACLF, acute-on-chronic liver failure; AKI, acute kidney injury (due to hepatorenal syndrome); CKD, chronic kidney disease; CLD, chronic liver disease; EAD, early allograft dysfunction; F, female; GRSVR, graft to recipient splenic volume ratio; GRWR, graft to recipient weight ratio; GW, graft weight; HBV, hepatitis B virus; HCC, hepatocellular carcinoma; HE, Hepatic encephalopathy; HPi, hyper-perfusion index; M, male; MOF, multi-organ failure; MRL, modified right lobe; NASH, non-alcoholic steatohepatitis; PHTN, portal hypertension; PNF, primary non-function; PVT, portal vein thrombosis; RL, right lobe.