Recipient-Related Preoperative and Intraoperative Risk Factors for Primary Graft Dysfunction After Orthotopic Liver...

Primary graft dysfunction (PGD) is a multifactorial syndrome related to the most adverse outcomes after liver transplantation. Ischemia-reperfusion injury is recognized as the predominant cause of this complication. PGD may be subdivided into early allograft dysfunction, diagnosed by the presence of a serum bilirubin level ≥10 mg/dL (171 μmol/L), International Normalized Ratio ≥1.6, or alanine and aspartate transaminase levels ≥2000 IU/L on the seventh postoperative day; and primary nonfunction, defined as either a need for retransplantation or patient death within the first 7 days. We aimed to determine the preoperative and intraoperative risk factors for PGD.

We enrolled 109 patients who underwent orthotopic liver transplantation between 2012 and 2016. Analysis included inter alia: biochemical parameters, morphology, blood transfusions, as well as intraoperative fluctuations of blood pressure.

Fourteen percent of patients were diagnosed with PGD. Using logistic regression and multivariate and receiver operating characteristic and area under the curve analysis, a preoperative neutrophils level above 4030/μL (OR = 4.03, P = .012) and decrease of the mean arterial pressure after reperfusion were recognized as the major independent PGD risk factors.

A high preoperative neutrophils level may be a novel recipient-related risk factor for PGD. A decrease of the arterial blood pressure after graft reperfusion may influence the development of PGD.