Initial poor function in the age of old donors: prognostic factors

The current donor selection criteria have changed from the past years. Primary nonfunction is a serious complication after liver transplantation, but initial poor function (IPF), which occurs from 2% to 23%, also has an increased morbidity and mortality. We analyzed prognostic factors associated with IPF.

This retrospective study of 551 liver transplants performed from January 2000 to December 2005 excluded retransplantations and transplants by classic surgery. The study cohort was attentified according to the presence or the absence of IPF. The variables included were (1) donor age, gender, cause of death, length of stay in Critical Care Medicine, noradrenaline use, sodium levels, and cardiorespiratory arrest, (2) from the standpoint of surgery: we included ischemia time (IT), intervention time, units of packet red cells (PRC), volume of blood autotransfusion (VBA), postreperfusion syndrome (PRS), and vasoactive drugs within the surgery procedure (VAD); (3) from the recipient's: view we examined age, gender, etiology, functional state, and covermittant pathology; (4) During the postoperative period we noted the presence of postoperative hemorrhage. Statistical analysis used chi-square test, Student t test, multiple logistic regression with significance set at P < .05.

Differences were found in IT (P = .001), VBA (P = .001), PRS (P = .012), VAD (P = .03), fulminant hepatic failure as the cause the transplantation (P = .002), and chronic obstructive pulmonary disease (P = .007). A regression model retained the following variables: IT, VBA, PRS, fulminant hepatic failure, and chronic obstructive pulmonary disease.

The prognostic factors for IPF need to be modified together with donor selection criteria in liver transplantation.