Liver—clinical experiencePrimary graft dysfunction after liver transplantation
Section snippets
Materials and methods
Primary adult OLTs (n = 322) with complete donor and recipient data (taking place from January 1986 to January 1999) were included in this study. IPF was defined as AST > 2000 IU/L on day 1 post-OLT,4 and PNF was defined according to criteria described by Ploeg et al.5 Potential risk factors assessed in this study included recipient age and pretransplant status, graft ischemic time (GIT), steatosis and donor factors (age, cardiac arrest, ICU stay > 5 days, inotropes, hypotension, alcoholism,
Results
PDF occurred in 98 (30.4%) cases in this series. Three (0.93%) cases were PNF, two of which involved grafts of severe steatosis. There were 95 (29.5%) cases of IPF. In the regression analysis, moderate (P = .009) and severe (P = .026) steatosis, and GIT (P = .022) were found to be independent significant risk factors for IPF. Other traditionally known “adverse” factors, including donor age > 50 years, high-dose inotropes, ICU stay > 5 days, cardiac arrest, hypotension, and recipient
Discussion
In the recent era of transplantation, improved retrieval technique, donor ICU care, and graft preservation has optimized the graft condition and thus reduced the negative impact of many traditionally known donor adverse factors. The more standardized transplant surgery and better intraoperative anesthetic support now available have meant that more poor-risk recipients can survive OLT. More effective immunosuppression has reduced post-Tx morbidity and mortality. It is therefore not surprising
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