Primary non-function is frequently associated with fatty liver allografts and high mortality after re-transplantation.

Kulik U, Lehner F, Klempnauer J et al.

Department of General-, Visceral- and Transplantation Surgery, Hannover Medical School, 30625, Hannover, Germany.

Liver international : official journal of the International Association for the Study of the Liver. Mar 2017.

The shortage of liver donations demands the use of suboptimal grafts with being a frequent finding. Although ≤30% macrovesicular steatosis is considered to be safe the risk for primary non-function (PNF) and outcome after re-transplantation (re-OLT) is unknown.Among 1205 orthotropic liver transplantations performed at our institution the frequency, survival and reason of re-OLT was evaluated. PNF (group A) cases and those with initial transplant function but subsequent need for re-OLT (group B) were analyzed. Histopathology and clinical judgment determined the cause of PNF and included an assessment of hepatic steatosis. Additionally, survival of allografts (group C) not requiring re-OLT was considered in Kaplan-Meier and multivariate regression analysis.A total of 77 high urgency re-OLTs were identified and included 39 PNF cases. Nearly 70% of PNF cases were due to primary fatty liver allografts. The 3-month in-hospital mortality for PNF cases after re-OLT was 46% and the mean survival after re-OLT was 0.5 years as compared to 5.2 and 5.1 years for group B, C, respectively (p<0.008). In multivariate Cox regression analysis only hepatic steatosis was associated with an inferior survival (HR 4.272, p=0.002). The MELD score, donor BMI, age, cold ischemic time, ICU stay, serum sodium and transaminases did not influence overall survival.Our study highlights fatty liver allografts to be a major cause for PNF with excessive mortality after re-transplantation. The findings demand the development of new methods to predict risk for PNF of fatty liver allografts. Pubmed

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