Outcome of Liver Transplantation Based on Donor Graft Quality and Recipient Status

Nemes, Balázs; Gelley, Fanni; Zádori, Gergely; Piros, László; Perneczky, J.; Kopper, László; Fehérvári, Imre; Görög, Dénes

doi:10.1016/j.transproceed.2010.05.018

Cited by 29 publications

(21 citation statements)

References 19 publications

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“…Laboratory changes reflecting liver metabolism and function in the first few days after transplantation, such as serum alanine aminotransferase (ALT) and aspartate aminotransferase (AST) levels, prothrombin time (PT), international normalized ratio (INR), and serum lactate and ammonia levels, are the most commonly used parameters. (2,(7)(8)(9)(10)(11)(12)(13)(14)(15) Early allograft dysfunction is known to be associated with lower graft and patient survival rates, longer stay at intensive care unit (ICU) and increased postoperative morbidity and mortality. (9) Previous studies taking time to dysfunction diagnosis as the driving factor for implementation of patient support therapy established the third postoperative day as the cut-off time for EAD.…”

Section: Early Allograft Dysfunctionmentioning

confidence: 99%

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

Neves

Rusi

Díaz

et al. 2016

Einstein (São Paulo)

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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.

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Section: Early Allograft Dysfunctionmentioning

confidence: 99%

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

Neves

Rusi

Díaz

et al. 2016

Einstein (São Paulo)

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“…PNF is a rare complication of liver transplantation, with a wide variation in its reported incidence from 0.9% to 7.2% (8-10). Reported etiologic factors of PNF are variable, including donor and recipient age, use of expanded-or extended-criteria donor livers, graft steatosis, smallfor-size syndrome (the graft volume is too small to satisfy the recipient's metabolic demand), and preservationreperfusion injury (6,(16)(17)(18)(19)(20). Authors of a previous in vivo study (21) reported that PNF grafts showed endothelial cell dysfunction and parenchymal edema with activation of Kupffer cells, overproduction of proinflammatory cytokines, and failure of antioxidant to be the best cutoff value, with an area under the curve of 0.929, sensitivity of 81%, and specificity of 100% for the differentiation of the PNF group from the non-PNF group.…”

Section: Discussionmentioning

confidence: 99%

CT Features of Primary Graft Nonfunction after Liver Transplantation

Kim¹,

Kwon²,

Kim³

et al. 2016

Radiology

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Purpose To determine computed tomographic (CT) features of primary graft nonfunction (PNF) after liver transplantation in comparison with those of early graft failure or death by identifiable causes. Materials and Methods Institutional review board approval was obtained and informed consent was waived. Among 3947 adult liver transplantations performed in one institution between May 2002 and May 2015, 72 patients died or had graft failure within 10 days, and 38 of them were evaluated with CT. PNF was diagnosed in 21 patients. The other 17 patients who died or had early graft failure were considered the non-PNF control group. On unenhanced CT images, graft attenuation was compared qualitatively. Graft attenuation was measured quantitatively and, if available, the difference between preoperative and postoperative CT (interval change) attenuation was evaluated. Unenhanced CT was evaluated for relative parenchymal enhancement. Statistical analyses included the Fisher exact and χ tests with Yates correction and the Student t test. Results On unenhanced CT images, grafts with PNF more commonly showed low (eight of 26 [31%]) or extremely low (18 of 26 [69%]) qualitative attenuation compared with grafts in the non-PNF group (three of 21 [14%], one of 21 [5%]; P < .001). The mean attenuation value (30.5 HU ± 10.8) was significantly lower and the mean interval change (24.7 HU ± 12.5) was significantly higher in the PNF group than in the non-PNF group (49.7 HU ± 8.0 and 9.7 HU ± 10.1, respectively; P < .001 and P = .001). There was no significant difference in the proportion of grafts that showed poor enhancement on postcontrast CT images between the PNF group and the non-PNF group (nine of 24 [38%] vs two of 20 [10%], respectively; P = .08). Conclusion Recipients with PNF after liver transplantation tended to show low or extremely low attenuation on unenhanced CT images, and this finding was seen more frequently in patients with PNF than in those who died of identifiable causes and in those with early graft failure. RSNA, 2016 Online supplemental material is available for this article.

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“…Saját eredményeink azt mutatják, hogy a máját-ültetés előtt beszűkült vesefunkció esetén egyúttal lé-nyegesen gyakoribb volt a diabetes mellitus, a hypertonia és a hepatorenalis szindróma, magasabb volt az átlagélet-kor és a dekompenzáció mértékét jelző átlagos MELDpontszám. Ezek együttesen szintén növelik az OLT során fellépő komplikációknak az esélyét [24].…”

Section: Megbeszélésunclassified

Kidney function and liver transplantation

et al. 2013

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Bevezetés: Májcirrhosisban a vesefunkció is romlik. Ennek hátterében leggyakrabban hepatorenalis szindróma áll, de primer vesebetegség, diabetes mellitus, valamint egyes alapbetegségek is okozhatják (például hepatitis C-vírus-fertőzés). Májtranszplantáció során számos további esemény (teljes vena cava kirekesztés, politranszfúzió, immunszuppresszió) is eredményezheti a veseműködés romlását. Célkitűzés: A veseműködés változásának vizsgálata máj-transzplantációt követően a posztoperatív első év alatt. Módszer: Primer májátültetésen átesett betegek (n = 319) adatait dolgozták fel retrospektív adatelemzéssel. Eredmények: Ha a veseműködés már preoperatív beszűkült volt, egyes posztoperatív szövődmények gyakrabban alakultak ki, és rosszabb volt az egyéves kumulatív betegtúlélés (91,7% vs. 69,9%; p<0,001). Ha az első év után a glomerulusfi ltrációs ráta 60 ml/perc/1,73 m 2 fölé emelkedett, javult a betegtúlélés. Függetlenül a vese preoperatív állapotától, az első év végig a betegek nagyobb részének (76%) romlott a veseműködése. Ebben a betegcsoportban gyakrabban alakult ki de novo diabetes mellitus (22,5% vs. 9,5%; p = 0,023). Következtetések: A veseelégtelenség kialakulásában jelentős szerepet játszó kockázati tényezők közül leginkább a személyre szabott immunszuppressziós terápia megválasztásán keresztül érhető el kedvező hatás. Orv. Hetil., 2013, 154, 1018-1025 Kulcsszavak: májátültetés, veseműködés, immunszuppresszió, hepatorenalis szindróma, hepatitis C Kidney function and liver transplantationIntroduction: In liver cirrhosis renal function decreases as well. Hepatorenal syndrome is the most frequent cause of the decrease, but primary kidney failure, diabetes mellitus and some diseases underlying endstage liver failure (such as hepatitis C virus infection) can also play an important role. In liver transplantation several further factors (total cross-clamping of vena cava inferior, polytransfusion, immunosuppression) impair the renal function, too. Aim: The aim of this study was to analyse the changes in kidney function during the fi rst postoperative year after liver transplantation. Method: Retrospective data analysis was performed after primary liver transplantations (n = 319). Results: impaired preoperative renal function increased the devepolment of postoperative complications and the fi rst year cumulative patient survival was signifi cantly worse (91,7% vs 69,9%; p<0,001) in this group. If renal function of the patients increased above 60 ml/min/1,73 m 2 after the fi rst year, patient survival was better. Independently of the preoperative kidney function, 76% of the patients had impaired kidney function at the fi rst postoperative year. In this group, de novo diabetes mellitus was more frequently diagnosed (22,5% vs 9,5%; p = 0,023). Conclusions: Selection of personalized immunosuppressive medication has a positive effect on renal function. Orv. Hetil., 2013, 154, 1018-1025

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Outcome of Liver Transplantation Based on Donor Graft Quality and Recipient Status

Cited by 29 publications

References 19 publications

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

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

CT Features of Primary Graft Nonfunction after Liver Transplantation

Kidney function and liver transplantation

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