Organ survival after primary dysfunction of liver grafts in clinical orthotopic liver transplantation

In a retrospective analysis of 632 orthototopic liver transplant procedures performed between 1982 and 1997, the incidence of primary dysfunction (PDF) of the liver and its influence on organ survival were studied. Graft function during the first 3 postoperative days was categorized into four groups: (1) good (GOT max1000 U/l, spontaneous PT50%, bile production100 ml/day); (2) fair (GOT 1000-2500 U/l, clotting factor support2 days, bile100 ml/day); (3) poor (GOT2500 U/l, clotting factor support2 days, bile20 ml/day); (4) primary non-function (PNF; retransplantation required within 7 days). The aim of this study was to evaluate graft survival comparing organs with PDF (poor function) and PNF vs organs with initial good or fair function. After a median follow-up of 45 months, initially good and fair function of liver grafts resulted in a significantly better long-term graft survival compared with grafts with initially poor function or primary non-function (if re-transplanted) (P0.01). The Cox model revealed primary function as a highly significant factor in the prediction of long-term graft survival (P0.0001). We conclude that these results confirm the hypothesis that primary graft function is of major importance for the long-term survival of liver transplants. Patients with a poor primary function have the worst survival prognosis, which leads to the interpretation that these patients may be candidates for early retransplantation.