POOR INITIAL GRAFT FUNCTION AFTER ORTHOTOPIC LIVER-TRANSPLANTATION - CAN IT BE PREDICTED AND DOES IT AFFECT OUTCOME - AN ANALYSIS OF 125 ADULT PRIMARY TRANSPLANTATIONS

Donor liver shortage is a persistent problem in liver transplantation. A more liberal donor acceptance policy may be a possible solution. Ho wever, this might put recipients at risk for initial poor function or even non-function of the graft. Therefore risk factors for initial gra ft dysfunction should be identified, preferably by using an uniform de finition of primary graft dysfunction or non-function. We retrospectiv ely analysed 125 adult liver transplantations in order to identify ris k factors for initial poor function and primary non-function. Donor, r ecipient pretransplant and surgical parameters were evaluated. Since t here is no consensus on the criteria of dysfunction we used two defini tions known from literature. No risk factors for postoperative dysfunc tion could be identified for either of the two definition sets. Furthe rmore, the definition set that included ALAT, prothrombin time and bil e production in the first 72 h to identify poor graft function showed no relation with graft or recipient outcome. The other set, using ASAT and prothrombin time, determined from day 2 to day 7, showed that pat ients with a primary dysfunction had significantly higher morbidity an d mortality compared to patients with a well functioning graft. We con clude that initial poor function after liver transplantation remains u npredictable, irrespective of the way it is defined. Moreover, our ana lysis shows that initial poor function can also develop in recipients that receive 'non-marginal' grafts without prolonged ischemia times. T hese results may support a more liberal selection of donor livers.