Primary graft dysfunction of the liver: definitions, diagnostic criteria and risk factors

Neves, Douglas Bastos; Rusi, Marcela Balbo; Diaz, Luiz Gustavo Guedes; Salvalaggio, Paolo

doi:10.1590/S1679-45082016RW3585

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Review • Einstein (São Paulo) 14 (4) • 2016 • https://doi.org/10.1590/S1679-45082016RW3585 copy

Primary graft dysfunction of the liver: definitions, diagnostic criteria and risk factors

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ABSTRACT

Primary graft dysfunction is a multifactorial syndrome with great impact on liver transplantation outcomes. This review article was based on studies published between January 1980 and June 2015 and retrieved from PubMed database using the following search terms: “primary graft dysfunction”, “early allograft dysfunction”, “primary non-function” and “liver transplantation”. Graft dysfunction describes different grades of graft ischemia-reperfusion injury and can manifest as early allograft dysfunction or primary graft non-function, its most severe form. Donor-, surgery- and recipient-related factors have been associated with this syndrome. Primary graft dysfunction definition, diagnostic criteria and risk factors differ between studies.

Transplantation; Primary graft dysfunction/diagnosis; Liver transplantation; Donor selection; Tissue and organ procurement; Risk factors

Author	Definition
Olthoff et al.⁽⁷⁾	At least one of the following parameters: bilirubin ≥10mg/dL on day 7; INR ≥1.6 on day 7; ALT or AST >2,000IU/L up to day 7
Ploeg et al.⁽⁸⁾	AST >2,000IU/L, TP >16 seconds and ammonia >50μmol/L from day 2 to day 7
Nanashima et al.⁽¹⁰⁾	AST or ALT >1,500IU/L in 2 consecutive tests within the first 72 hours
Dhillon et al.⁽¹¹⁾	[(ALT+AST)/2] >986IU/L on day 2

Author	Definition
Ploeg et al.⁽⁸⁾	Liver function inconsistent with life; need for retransplantation or progression to death within seven days of surgery
Nanashima et al.⁽¹⁰⁾	AST or ALT >1,500IU/L in 2 consecutive tests within the first 72 hours, requiring retransplantation or progressing to recipient death
Dhillon et al.⁽¹¹⁾	[(ALT+AST)/2] >986IU/L on day 2, requiring retransplantation or progressing to recipient death up to day 7
Broering et al.⁽¹²⁾	Need for retransplantation up to day 10 or death due to graft nonfunction
Máthé et al.⁽²⁸⁾	AST or ALT >1,500IU/L in 2 consecutive tests within the first 72 hours, leading to retransplantation or recipient death
Kremers et al.⁽²⁷⁾	ALT >2,500IU/L, blood glucose levels <60mg/dL, INR >2.5 or bile flow <50mL/d

Donor	Surgical procedure	Recipient
Steatosis macro ≥30%^(34-36)	Hot ischemia time >40 minutes⁽³⁹⁾ >45 minutes⁽⁴⁴⁾	Young recipients (tend to receive organs from expanded criteria donors)^(5,8,39,43)
Expanded criteria donors^(1,4,7)	Cold ischemia time >10 hours^(8,43)
Age >49 years^(8,43)
>65 years⁽³⁰⁾

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E-mail: revista@einstein.br

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[1] Corresponding author: Douglas Bastos Neves – Rua Sacadura Cabral, 178, 8th floor – Saúde – Zip code: 20221-903 – Rio de Janeiro, RJ, Brazil – Phone: (55 21) 2291-3131 – E-mail: douglas.bastos@hepatobiliar.com