Raykateeraroj N.Lee D.K.Albert Suh J.M.Kitisin N.Dewapura S.Caragata R.Freeman T.Botta H.Yin Z.Flinkier A.Tran N.Karalapillai D.Fischer C.Perini M.Fink M.Weinberg L.Mahidol University2026-04-292026-04-292026-06-01Journal of Surgical Research Vol.322 (2026) , 458-47000224804https://repository.li.mahidol.ac.th/handle/123456789/116348Introduction: Dextran-40 has rheological and antithrombotic effects that could modulate early allograft injury, but contemporary evidence in adults is limited. We evaluated whether early postoperative dextran-40 use was associated with improved graft outcomes. Methods: In this single-center retrospective cohort, we studied 900 adult liver transplant recipients (2009–2023) using a 48-h landmark to reduce immortal-time bias; 883 patients alive with their primary graft at 48 h formed the analytic cohort. Early exposure was defined as starting dextran-40 within 48 h after transplantation versus later or no dextran. Confounding was addressed with propensity score overlap weighting. Primary outcomes were primary nonfunction, early allograft dysfunction, and 30-day graft loss. Results: In the overlap-weighted analyses, early dextran-40 was associated with lower 30-day graft loss (2.0% versus 7.6%; risk difference −5.6 percentage points, 95% confidence interval −10.5 to −0.7). Rates of primary nonfunction, early allograft dysfunction, mortality, thrombotic events, acute kidney injury, and reoperation for bleeding did not differ meaningfully between groups. Conclusions: In this contemporary cohort, early dextran-40 administration was associated with better short-term graft survival without evidence of safety concerns. These observational findings warrant confirmation in prospective multicenter trials.MedicineArticleSCOPUS10.1016/j.jss.2026.03.0832-s2.0-10503635520810958673