Primary graft nonfunction in liver transplantation: can we predict? A single-center experience

Background
Primary nonfunction (PNF) after liver transplantation is a lethal condition, requiring immediate retransplantation. The precise cause is not well known yet. The aim of this study is to determine the incidence of PNF in our liver recipients, potential risk factors, and outcome.
Patients and methods
A total of 248 adult liver transplant recipients from 2014 till 2017 at our Transplant Unit were included after excluding nine patients for missing data. Of 248 patients, five (2%) had PNF; two of these patients have been excluded for the purpose of data analysis, as they had machine perfusion (One Liver Assist, and the other Organox). Of the non-PNF 243 recipients, 36 patients receiving livers from donors undergoing in-situ normothermic regional perfusion or ex-situ normothermic perfusion were not included, leaving 207 patients, so the total number was 210 patients. Donor and graft variables studied including age, BMI, serum sodium, cold ischemia time, warm ischemia time, operative time, graft type, and severity of steatosis. Recipient variables included primary liver disease; United Kingdom Model for End-Stage Liver Disease (UKELD) score; posttransplant biochemistry; potential risk factors, including dialysis, inotropes, mechanical ventilation, and pretransplant portal vein thrombosis; hospital and ICU stay; and patient survival.
Results
UKELD score was the only significant recipient variable (=0.044). Among donor and graft variables, notably all PNF patients received donation after circulatory death grafts. Posttransplant laboratory values were strikingly worse, clearly indicating more pronounced hepatic and renal impairment in PNF group. Creatinine levels on days 1, 3, and 5 were significantly worse. Hospital and ICU stays were longer for PNF group, with ICU stay significantly longer [median of 7 vs. 2 days (=0.014)], with no death in PNF group.
Conclusion
The main risk factors for PNF in our practice were donation after circulatory death grafts and more sick (higher UKELD) recipients.