Researchers at Toronto General Hospital Research Institute (TGHRI) and the Ajmera Transplant Centre have identified an important early warning sign that could help doctors predict the success of liver transplants.
UHN’s Multi-Organ Transplant Program, which includes its Liver Program, at Ajmera Transplant Centre, is the largest transplant program in Canada, with world-renowned researchers studying clinical transplantation and modelling human disease.
Liver transplants are considered a first-line treatment for end-stage liver disease and the only curative option for many patients with hepatocellular carcinoma—the most common type of liver cancer. However, the need for donor tissue is greater than the supply.
To increase the availability of donor tissue, more types of grafts—tissue taken from one part of the body and used to replace diseased or injured tissue—are being used. These grafts, while broadening the donor pool, can come from older donors or organs in poorer health and therefore have an increased likelihood of causing graft dysfunction.
Thus, there is a need for an early and accurate way to assess grafts for dysfunction post-transplant. Blood clotting proteins have previously been studied as a marker of liver function, but research in this area has been limited. One of these proteins, known as Factor V, is solely produced in the liver and a previous, retrospective study has linked its levels with graft loss.
To further validate the use of Factor V as a marker of graft function and expand the current understanding of its role in liver function, the team followed 129 liver transplant patients, measuring Factor V levels at various points after the procedure. They then analyzed graft and patient survival at three, six, and twelve months.
The researchers identified an optimal Factor V level that can predict graft and patient outcomes. They found that patients with Factor V levels below 0.46 U/mL on the first day after surgery had lower graft and patient survival rates compared to those with higher levels. Specifically, at one year, 98.8% of patients with higher Factor V levels experienced graft survival, compared to just 87.7% of those with lower levels. Patient survival also dropped from 95% to 82.9% in the low-Factor V group.
These results suggest that Factor V could serve as a valuable early indicator, helping doctors identify patients at risk and adjust treatments accordingly. More studies are needed to confirm these findings and determine how this biomarker could improve transplant outcomes.
First author of this study is Annabel K. Gravely, research student with the liver transplant oncology research group that Dr. Gonzalo Sapisochin leads at UHN.
Senior author of this study is Dr. Gonzalo Sapisochin (link is external), Clinician Investigator at Toronto General Hospital Research Institute (TGHRI), Staff Surgeon at Toronto General Hospital, and Associate Professor of Surgery at the University of Toronto.
This work was supported by the Natural Sciences and Engineering Research Council of Canada, and UHN Foundation.
Gravely AK, Claasen MPAW, Ivanics T, Winter E, Peralta P, Selzner M, Sapisochin G. Factor V Serves as an Early Biomarker for Graft Loss After Liver Transplant: A Prospective Evaluation (link is external). Clin Transplant. 2025 Feb;39(2):e70086. doi: 10.1111/ctr.70086.