From the Guidelines
Primary liver graft non-function is a life-threatening condition requiring urgent retransplantation, whereas graft dysfunction is a less severe condition that may be reversible with medical management. The key difference between primary liver graft non-function and graft dysfunction in a liver transplant patient lies in the severity of liver impairment and the potential for recovery. Primary non-function is characterized by complete liver failure, marked by persistent coagulopathy, hypoglycemia, minimal or no bile production, high transaminases, metabolic acidosis, and hemodynamic instability within the first 24-72 hours post-transplant 1. In contrast, graft dysfunction represents a less severe condition where the liver shows impaired but not absent function, with abnormal liver function tests, reduced bile production, and clinical signs of liver impairment, but maintaining some metabolic activity.
Some key features of primary liver graft non-function include:
- Persistent coagulopathy
- Hypoglycemia
- Minimal or no bile production
- High transaminases
- Metabolic acidosis
- Hemodynamic instability These features are typically observed within the first 24-72 hours post-transplant and are indicative of a catastrophic condition that requires urgent retransplantation as the only definitive treatment. On the other hand, graft dysfunction may present with:
- Abnormal liver function tests
- Reduced bile production
- Clinical signs of liver impairment
- Some metabolic activity
The causes of primary liver graft non-function and graft dysfunction can be similar, including preservation injury, technical complications, immunological factors, or donor-related issues 1. However, the distinction between the two conditions is crucial, as primary non-function almost always requires immediate retransplantation, whereas graft dysfunction may be reversible with appropriate medical management. Retransplantation for primary graft non-function is a complex procedure with significant morbidity and mortality, and the outcome is significantly lower than for primary transplantation, with 1-, 3-, and 5-year survival rates approximately 20% lower than for primary transplantation 1.
From the Research
Definition and Diagnosis
- Primary liver graft non-function (PNF) and graft dysfunction are two related but distinct entities that can occur after liver transplantation 2, 3, 4, 5, 6.
- PNF is a severe form of graft dysfunction, characterized by the failure of the transplanted liver to function immediately after transplantation 4, 5.
- Graft dysfunction, on the other hand, can manifest as early allograft dysfunction (EAD) or primary graft dysfunction (PGD), which can range from mild to severe 2, 3, 6.
Risk Factors
- Both PNF and graft dysfunction are multifactorial, with donor-, recipient-, and procedure-related factors contributing to their development 2, 3, 4, 5, 6.
- Ischemia-reperfusion injury is a major driver of graft dysfunction and PNF 2, 4, 5, 6.
- Other risk factors include donor age, graft quality, recipient illness, and surgical techniques 3, 5, 6.
Management and Treatment
- The management of PNF and graft dysfunction involves early diagnosis and aggressive treatment, including pharmacological interventions and machine perfusion strategies 2, 4, 5.
- Reducing risk factors and improving graft quality can help decrease the incidence of PNF and graft dysfunction 5.
- In severe cases of PNF, re-transplantation may be necessary to salvage the patient 4, 5.