PLASMAPHERESIS IN PRIMARY DYSFUNCTION OF HEPATIC TRANSPLANTS

Background: Primary dysfunction is a failure of graft function which o ccurs in approximately 5% of transplanted livers. Retransplantation is often required. The presence of elevated serum cytokines interleukin 6 and tumor necrosis factor with hepatic graft dysfunction, as well as the historical benefit of plasmapheresis in fulminant hepatic failure -associated coma suggest a possible role for plasmapheresis therapy in the management of primary graft dysfunction in liver transplantation. Design and Methods: We evaluated the effectiveness of plasmapheresis in the management of primary graft dysfunction in 18 patients who unde rwent orthotopic liver transplantation in this institution. Patients w ho were diagnosed with primary dysfunction of hepatic grafts underwent a course of four daily plasma exchange procedures. The clinical outco me, patient and graft survival, was compared to that of historical con trols. Results: Graft survival at 10 days was 77.7% and 76.2% and pati ent survival at 100 days was 83.3% and 85.7% in the plasmapheresed and control groups, respectively. The patients who underwent plasmapheres is had a higher incidence of dialysis intervention, 38% versus 19%, in dicating more severe graft dysfunction. In the small number of patient s compared for concomittant dialysis therapy, patient survival in the plasmapheresed group was 85.7% versus 50% (control), and graft surviva l was 57.0% versus 50%. Serum cytokine levels of tumor necrosis factor and interleukin 6 were reduced by 66.0% and 55.2%, respectively, with a single procedure. Conclusion: Plasmapheresis did not significantly effect graft survival in patients with primary graft dysfunction. An i ncrease in patient survival in severe graft dysfunction with renal fai lure was noted but was not significant. Removal of elevated serum cyto kines TNF and IL-6 was documented. (C) 1996 Wiley-Liss, Inc.