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

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.
• 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.