Early Allograft Dysfunction (EAD) Criteria

Olthoff EAD Criteria (any one = EAD positive)

Bilirubin Unit

Day 7 Bilirubin (mg/dL)

EAD threshold: ≥ 10 mg/dL

Day 7 INR

EAD threshold: ≥ 1.6

Peak ALT within POD 1–7 (IU/L)

EAD threshold: ≥ 2000 IU/L

Peak AST within POD 1–7 (IU/L)

EAD threshold: ≥ 2000 IU/L

EAD Definition (Olthoff Criteria)

EAD is present if ANY ONE of the following three criteria is met within the first 7 postoperative days after liver transplantation:

Note: criteria 3 is met if EITHER ALT or AST reaches ≥ 2000 IU/L — only one of the two transaminases needs to be elevated.

Condition	Definition	Incidence	Clinical Course
Normal Function	All labs improving POD 1–7	—	Discharge by week 2–3
EAD	Any one Olthoff criterion	20–30%	Prolonged ICU; higher re-transplant risk
PNF	AST >5000 + INR >2.5 + organ failure	2–5%	Requires urgent re-transplant

EAD occurs in 20–30% of liver transplants and doubles long-term graft failure risk
EAD does not mandate re-transplantation — many EAD grafts recover with supportive care
Machine perfusion (normothermic machine perfusion, NMP) significantly reduces EAD incidence
EAD is independently associated with donor DRI >2.0 and recipient SOFT score >30
PNF is a surgical emergency — MELD exception points must be applied urgently for re-listing
PNF diagnostic criteria require AST >5000 IU/L AND INR >2.5 AND at least one of: oliguria/anuria, arterial pH <7.30, severe coagulopathy

Olthoff KM, et al. Validation of a current definition of early allograft dysfunction in liver transplant recipients and analysis of risk factors. Liver Transpl. 2010;16(8):943–949.
Nasralla D, et al. A randomized trial of normothermic preservation in liver transplantation. Nature. 2018;557(7703):50–56.