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Primary nonfunction (PNF) in the MELD Era: An SRTR database analysis.

S R Johnson1, S Alexopoulos, M Curry

  • 1The Transplant Center, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA. srjohnso@bidmc.harvard.edu

American Journal of Transplantation : Official Journal of the American Society of Transplantation and the American Society of Transplant Surgeons
|February 9, 2007
PubMed
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Primary graft dysfunction (PGD) after liver transplantation (LT) remains a severe risk. This study found PGD incidence did not increase with Model for End-Stage Liver Disease (MELD) allocation, with donor age and recipient illness severity being key risk factors.

Area of Science:

  • Hepatology
  • Transplantation Surgery
  • Critical Care Medicine

Background:

  • Primary graft dysfunction (PGD) is a rare but critical complication following liver transplantation (LT).
  • Liver allocation policies, such as the Model for End-Stage Liver Disease (MELD) score, prioritize recipients based on illness severity, a known risk factor for PGD.
  • The incidence of PGD in the era of MELD-based liver allocation had not been previously reported.

Purpose of the Study:

  • To determine the incidence of PGD after LT since the implementation of MELD.
  • To identify risk factors associated with PGD in adult deceased donor LT recipients under MELD allocation.
  • To compare PGD rates in the MELD era with historical data.

Main Methods:

  • Analysis of the Scientific Registry of Transplant Recipients (SRTR) database from MELD inception until September 2004.

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  • Inclusion of adult deceased donor LT recipients.
  • Definition of PGD as graft loss or death within 14 days of LT due to PGD or undefined causes.

    • Main Results:

    • A total of 10,545 transplants were analyzed, with PGD occurring in 613 recipients (5.81%).
    • Univariate analysis identified donor age, recipient serum creatinine >1.5 mg/mL, hypertension, and cerebrovascular accident (CVA) as risk factors.
    • Multivariate analysis revealed donor age, recipient serum creatinine, bilirubin, requirement for life support, and status 1 at transplant as significant risk factors for PGD.

    Conclusions:

    • The incidence of PGD following LT in the MELD era has not increased compared to previous reports.
    • Key risk factors for PGD are associated with donor age and the severity of the recipient's illness.
    • Recipient factors such as serum creatinine, bilirubin levels, need for life support, and pre-transplant status are critical predictors of PGD.