- Email: [email protected]
Graft Failure: Etiology, Recognition, and Treatment
Graft Failure: Etiology, Recognition, and Treatlllent NICHOLAS N. NISSEN STEVEN D. COLQUHOUN
Definition
915
Incidence
916
Challenge
916
Diagnosis 917 Etiology 917 Donor-related factors 918 Procurement-related factors 922 Recipient-related factors 922 Predictors of primary nonfunction and initial poor function 922 Treatment 923 Avoidance 923 Graft hepatectomy 924 Retransplantation 924 Specific treatment of primary nonfunction 924 Liver assist devices 925 Blocking ischemia/reperfusion Injury 925 Small-for-size syndrome 925 Conclusions/summary
925
Although there have been many dramatic advances in the field of liver transplantation in the past 10 years, the problems of overcoming graft dysfunction and failure have been less gratifying. Despite better understanding of the associations, risks, and probable mechanisms of graft failure, truly effective interventions have remained more elusive. The increasing shortage of organs for transplantation has forced the use of allografts with even more expanded criteria for selection, as well as allocation to progressively more decompensated recipients, thereby resulting in increasingly fewer organs for retransplantation. 1 It has also led to the use of living donor transplantation, which has brought its own set of issues related to graft function. These facts have now made the problem of graft dysfunction and failure more important than ever. The objective of this chapter is to comprehensively review the issues relevant to early functioning of allografts so that when feasible, risk factors can be prevented, dysfunction recognized, and appropriate measures taken to avoid poor outcomes.
Definition "A diagnosis of PNF [primary nonfunction] is made by exclusion, when early graft failure develops and no significant causal factor can be identified."2 915
Definition
915
Incidence
916
Challenge
916
Diagnosis 917 Etiology 917 Donor-related factors 918 Procurement-related factors 922 Recipient-related factors 922 Predictors of primary nonfunction and initial poor function 922 Treatment 923 Avoidance 923 Graft hepatectomy 924 Retransplantation 924 Specific treatment of primary nonfunction 924 Liver assist devices 925 Blocking ischemia/reperfusion Injury 925 Small-for-size syndrome 925 Conclusions/summary
925
Although there have been many dramatic advances in the field of liver transplantation in the past 10 years, the problems of overcoming graft dysfunction and failure have been less gratifying. Despite better understanding of the associations, risks, and probable mechanisms of graft failure, truly effective interventions have remained more elusive. The increasing shortage of organs for transplantation has forced the use of allografts with even more expanded criteria for selection, as well as allocation to progressively more decompensated recipients, thereby resulting in increasingly fewer organs for retransplantation. 1 It has also led to the use of living donor transplantation, which has brought its own set of issues related to graft function. These facts have now made the problem of graft dysfunction and failure more important than ever. The objective of this chapter is to comprehensively review the issues relevant to early functioning of allografts so that when feasible, risk factors can be prevented, dysfunction recognized, and appropriate measures taken to avoid poor outcomes.
Definition "A diagnosis of PNF [primary nonfunction] is made by exclusion, when early graft failure develops and no significant causal factor can be identified."2 915