RISK-FACTORS FOR PRIMARY DYSFUNCTION AFTER LIVER-TRANSPLANTATION - A MULTIVARIATE-ANALYSIS

In a retrospective analysis on 323 ortholopic liver transplant procedu res performed between July 1984 and October 1991 the incidence of two forms of primary dysfunction (PDF) of the liver: primary nonfunction ( PNF), and initial poor function (IPF) were studied. The incidence of P DF was 22% (73/323) with 6% PNF (20/323) and 16% IPF (53/323), while 7 8% (250/323) had immediate function (IF). Occurrence of both IPF and P NF resulted in a higher graft failure rate (P<0.001), retransplantatio n rate (P<0.001), and patient mortality (P<0.003) within the first thr ee months after OLTx. Univariate analyses of donor and recipient facto rs and their influence on PDF demonstrated that, longer donor hospital ization (>3 days), older donor age (>49 years), extended preservation times (>18 hr), and fatty changes in the donor liver biopsy, as well a s reduced-size livers, younger recipient age, and renal insufficiency prior to OLTx, significantly affected the incidence of IPF and PNF. Mu ltivariate analysis of potential risk factors showed that reduced-size liver (P=0.0001), fatty changes on donor liver biopsy (P=0.001), olde r donor age (P=0.009), retransplantation (P=0.01), renal insufficiency (P=0.02), and prolonged cold ischemia times (P=0.02) were independent ly associated with a higher incidence of IPF and PNF. No statistical c orrelation was found between PDF and etiology of ESLD, nutritional sta tus of the recipient, UNOS status, and Child-Pugh classification in th is study. We conclude that PNF and IPF are both separate clinical enti ties that have a significant effect on outcome after OLTx. Routine don or liver biopsies are recommended to decrease the rate of IPF and PNF. The combination of risk factors shown to be significant for PDF shoul d be avoided-and, if that, is not possible, the only variable that can be controlled, the preservation time, should be kept as short as poss ible.