Impact of donor, recipient, and graft features on the development of primary dysfunction in liver transplants.
OBJECTIVE
To establish the utility of eight anatomic/pathologic suboptimal and 9 others graft features, versus in 20 donor versus 14 recipient characteristics to predict primary transplant dysfunction.


METHODS
We reviewed 248 consecutive liver transplants performed at the Hospital Ramón y Cajal, Madrid, in 206 patients over a 79-month period. At least one biopsy specimen was obtained from 169 grafts (68.1%). Recipients were classified as showing primary function or dysfunction, the latter group being subdivided into primary failure and inadequate initial function. The primary function and inadequate initial function groups were defined in terms of transaminases less or more than 2000 IU and prothrombin activity over or under 50%, respectively during posttransplant days 2 to 7.


RESULTS
The following graft-related rates were recorded: arteriopathy 6.5%, steatosis 29.4% (macrovesicular 26.4%, microvesicular 4.7%, or both 1.7%), hepatocyte vacuolization 14.2%, sinusoidal ectasia 12.4%, hepatocellular necrosis 44.7%, and neutrophilic infiltration 24.4%. The only significant factors in the multivariate analysis were cause of donor death other than cranioencephalic trauma (P=.032) and moderate steatosis (30%-60% affected hepatocytes); (P=.012).


CONCLUSIONS
The only factors that seem to influence the development of primary liver dysfunction were a moderate degree of graft steatosis and a cause of brain death other than cranioencephalic trauma.
Fernández-Merino
F J
FJ
Transplant Unit, Department of Digestive Surgery, Madrid, Spain. ffernandez@hrc.insalud.es
Nuño-Garza
J
J
López-Hervás
P
P
López-Buenadicha
A
A
Moreno-Caparrós
A
A
Quijano-Collazo
Y
Y
Sanjuanbenito
A
A
Vicente-López
E
E
D001794:Blood Pressure; D015992:Body Mass Index; D022781:Hepatocytes / Q000378:metabolism; D006801:Humans; D015994:Incidence; D008112:Liver Glycogen / Q000378:metabolism; D016031:Liver Transplantation / Q000009:adverse effects / Q000502:physiology* / Q000706:statistics & numerical data; D011183:Postoperative Complications / Q000145:classification / Q000453:epidemiology; D012189:Retrospective Studies; D014019:Tissue Donors / Q000706:statistics & numerical data*; D017211:Treatment Failure
D008112:Liver Glycogen