Primary Graft Dysfunction After Living Donor Liver Transplantation Is Characterized by Delayed Functional Hyperbilirubinemia

Abstract

The purpose of this study is to propose a new concept of primary graft dysfunction (PGD) after living donor liver transplantation (LDLT), characterized by delayed functional hyperbilirubinemia (DFH) and a high early graft mortality rate. A total of 210 adult-to-adult LDLT grafts without anatomical, immunological or hepatitisrelated issues were included. All of the grafts with early mortality (n = 13) caused by PGD in LDLT had maximum total bilirubin levels >20 mg/dL after postoperative day 7 (p < 0.001). No other factors, including prothrombin time, ammonia level or ascites output after surgery were associated with early mortality. Thus, DFH of >20 mg/dL for >seven consecutive days occurring after postoperative day 7 (DFH-20) was used to characterize PGD. DFH-20 showed high sensitivity (100%) and specificity (95.4%) for PGD with early mortality. Among the grafts with DFH-20 (n = 22), those with early mortality (n = 13) showed coagulopathy (PT-INR > 2), compared with those without mortality (p = 0.002). Pathological findings in the grafts with DFH-20 included hepatocyte ballooning and cholestasis, which were particularly prominent in the centrilobular zone. PGD after LDLT is associated with DFH-20 caused by graft, recipient and surgical factors, and increases the risk of early graft mortality.

Clinical outcomes of living donor liver transplantation for patients 65 years old or older with preserved performance status

“…It is well accepted that the graft quality, including the graft size and the donor age, and the recipient condition, including the patient status, the MELD score, and the extent of portal hypertension, are determinants of recipient outcomes . We previously reported that advanced donor age, recipient hospitalization, and high MELD scores were among the risk factors for postoperative primary graft dysfunction with severe hyperbilirubinemia . In the current study, all of the donors for the elderly recipients were their children.…”

Liver graft hyperperfusion in the early postoperative period promotes hepatic regeneration 2 weeks after living donor liver transplantation

“…This syndrome is defined as delayed functional hyperbilirubinemia: total serum bilirubin > 20 mg/dL for >7 consecutive days occurring after the 7th POD, excluding technical, immunological, and hepatitis factors. [17] …”

Reduced-Dose Telaprevir-Based Triple Antiviral Therapy for Recurrent Hepatitis C After Living Donor Liver Transplantation

“…Patients with (i) recent acute cellular rejection or hepatic decompensation, (ii) Hb less than 10.0 g/L, (iii) eGFR (mL/min/1.73 m 2 ) of 0.808 (coefficient for Japanese population) Â 175 Â serum creatinine j1.154 Â age j0.203 Â 0.742 (if female) (25), or (iv) nonYgenotype 1 HCV were ineligible for triple antiviral therapy. The surgical procedures used for the donors and recipients are described elsewhere (26). In our institute, splenectomy is performed in recipients with hepatitis C to prevent pancytopenia during antiviral therapy (27).…”