Primary graft dysfunction of the liver: definitions, diagnostic criteria and risk factors

Abstract

Primary graft dysfunction is a multifactorial syndrome with great impact on liver transplantation outcomes. This review article was based on studies published between January 1980 and June 2015 and retrieved from PubMed database using the following search terms: "primary graft dysfunction", "early allograft dysfunction", "primary non-function" and "liver transplantation". Graft dysfunction describes different grades of graft ischemia-reperfusion injury and can manifest as early allograft dysfunction or primary graft non-function, its most severe form. Donor-, surgery-and recipient-related factors have been associated with this syndrome. Primary graft dysfunction definition, diagnostic criteria and risk factors differ between studies.

Predictive model and risk factors associated with a revised definition of early allograft dysfunction in liver transplant recipients

“…However, even if higher ALT/AST levels partially overlap with UNOS definition of PNF, only 5% (9/164) developed PNF in the newly defined EAD group. While both EAD and PNF are describing different degrees of graft injury, the common denominator is the need for early retransplantation or progression to patient death up to day 7 . The progression to PNF appears to be low and unpredictable in our study.…”

“…EAD was previously defined when one or more of the following graft function variables were present: bilirubin ≥ 10 mg/dL and INR ≥ 1.6 on postoperative day 7; alanine aminotransferase (ALT) or aspartate aminotransferase (AST) > 2000 IU/mL within the first week postoperatively . Primary graft nonfunction per UNOS criteria was included as a measure of EAD . We defined 6‐month patient and graft failure as patient death, graft failure at time of death, or failure with retransplantation.…”

“…9 Primary graft nonfunction per UNOS criteria was included as a measure of EAD. 10 We defined 6-month patient and graft failure as patient death, graft failure at time of death, or failure with retransplantation. Postreperfusion syndrome (PRS) was previously defined.…”

Clinical and Immunological Assessment of Renal Transplant Recipients / Avaliação Clínica e Imunológica dos Receptores de Transplante Renal

“…18 There was a significant relationship between the length of hospital stay and renal graft dysfunction (p<0.01), demonstrating that the longer the hospital stay plus the risk of graft dysfunction, the patient may present, a result corroborated in the literature. 19 The study demonstrated a significant reduction in rejection rates, as the literature bring changes in detection and treatment directly contributing to this reduction. It is worth noting that a statistically significant relationship between cellular rejection and PRA class I (p<0.05) and between humoral rejection and PRA class I and class II (p<0.05) was evidenced.…”

Management of Patients with Liver Transplantation in ICU

“…Primary graft dysfunction (PGD) is a major complication after LT and is associated with prolonged hospital and ICU stay jeopardizing graft viability, being responsible for its high rejection rates as well as higher mortality and morbidity. It describes different degrees of graft impairment which begins intraoperatively, divided into early or initial poor function (IPF) and primary nonfunction (PNF) [89][90][91]. IPF represents the clinical phenotype of severe ischemia-reperfusion injury due to various donor and/or recipient-related factors.…”