Risk factors for primary poor function in liver transplantation: a retrospective single centre analysis

Background:

Primary poor function (PPF) complicates liver transplantation and results in poor outcomes. Recipients who develop PPF, experience longer hospital stay, higher mortality and graft loss rates. The aim of this analysis was to assess PPF as an intermediate outcome measure in a large single centre cohort and to correlate PPF with donor, recipient and peri-operative risk factors.

Methods:

PPF was defined as the presence of one or more of previously defined postoperative laboratory analyses: bilirubin ≥10 mg/dL on day 7; international normalized ratio ≥1.6 on day 7, aspartate aminotransferases > 2,000IU/L on day 1 – 7; PPF was assessed in a cohort of 767 liver transplants performed between 2007 and 2018. The effect of PPF on recipient and graft survival was analysed and risk factors for PPF were assessed using multivariate analyses and the Kaplan-Meyer method.

Results:

The incidence of PPF was 31.3%. 1-, 3-, 5-year graft and patient survival were worse in patients with PPF than in those without (P < 0.01 at all time points). Multivariate analysis showed associations between PPF and re-transplantation, recipient hepatitis-C-positive status, (P < 0.05), recipient graft Child Score (P < 0.01), cold ischemia time (P < 0.05), anastomosis time, post-operative hematoma (P < 0.01), donor BMI, donor graft steatosis, donor GGT (P < 0.01). Patients with PPF had a significantly longer hospitalisation (30.8 ± 23.3 days compared to 26.5 ± 19.8 days, P < 0.01).

Conclusion:

Recipient-, surgery- and donor-related factors have been associated with PPF. The combination of such risk factors poses a significant for PPF and should be avoided.