Cause and timing of first allograft failure in orthotopic liver transplantation: A study of 177 consecutive patients

Abstract

The cause and timing of first liver allograft failure was evaluated in 177 patients who underwent a second liver transplant between January 1984 and December 1988. The population studied consisted of 94 men and 83 women with a mean age 41.3 ± 1.0 yr (mean ± S.E.M.). Mean first-graft survival was 130.6 ± 22.9 days (range = 0 to 2.073 days). Sixty·eight percent of the grafts failed in the first postoperative month. 26% failed between the second and twelfth month and only 6% failed beyond the twelfth month from the date of the initial transplant. Six principal causes of graft failure were identified. Early allograft losses occurred as a result of four major problems: primary graft nonfunction (30.0% of all grafts; mean graft survival = 3.4 ± 0.3 days); ischemic injury of the graft without overt vascular injury (9.6%; mean graft survival = 17.5 ± 1.9 days); acute rejection (10.7%; mean graft survival = 30.4 ± 6.4 days); and overt vascular complications (26.6%; mean graft survival = 59.6 ± 24.1 days). Late graft failures were the result of either chronic rejection (11.3%: mean graft survival = 496.3 ± 138.0 days) or recurrence of the primary liver disease (6.8%: mean graft survival = 550.5 ± 172.1 days). Graft failure occurred as a result of a variety of miscellaneous causes in 5% of the cases (mean graft survival in this group = 300.0 ± 110.6 days). Overall 6-mo patient survival after a second liver transplant was 46.3%. Patients who had a retransplant because of chronic rejection and ischemic injury had the greatest (65%) and least (23%) 6-mo survival rates respectively after second grafting (p < 0.05). Those who survived the second transplant procedure for 6 mo or more tended to be younger (p < 0.01) and had a reduced first transplant requirement for red blood cells (p < 0.05), platelets (p < 0.01) and fresh frozen plasma (p < 0.01) than did those who died during the 6 mo after their second transplant procedure.

Outcome after living donor liver transplantation: A comprehensive retrospective analysis of the risk factors for morbidity, mortality and graft failure in a tertiary care center

“…This represents the lowest of the recorded graft failure in world literature which ranged between 9.0%-27.0% [147][148][149][150]. The Cause of early graft failure in the present study were the same as those reported in cadaveric liver transplantation [65,97,151,152]. Primary non-function (PNF] which was reported to be the commonest cause of early graft failure in cadaveric liver transplantation [150].…”

Persistent Cytomegalovirus in Liver Allografts With Chronic Rejection

“…The rejection episodes were treated with high doses to 10% of liver allografts. [1][2][3] Histological criteria include the of methylprednisolone, and in the case of steroid resistent rejection, disappearance of bile ducts, vanishing bile duct syndrome with OKT3 or anti-thymocyte-globulin.…”

“…The diagnosis of CMV infection was based tive arteritis. [1][2][3][4][5][6] Obliterative arteriopathy, which is characteron viral culture, antigen detection, and serology. The severe, sympistic of chronic rejection, may also sometimes occur without tomatic CMV infections were either treated with ganciclovir alone, VBDS.…”

The caspase inhibitor IDN-6556 prevents caspase activation and apoptosis in sinusoidal endothelial cells during liver preservation injury

“…12,13 These proteases are synthesized as proenzymes and activated by proteolytic processing by other caspases. 12 Of caspases cloned and identified to date, caspases 2,3,6,7,8,9, and 10 have been implicated most strongly in apoptosis. 12 All these caspases have a cysteine residue in their active site and recognize aspartate in the p1 position of the substrate.…”