Graft primary non-function (PNF) is the most severe complication after orthotopic liver transplantation (OLT) and is frequently associated with livers from uncontrolled donors after circulatory death (uDCD).
The incidence of PNF among our study of 75 patients who underwent OLT using uDCD livers was 8%. We compared patients who developed PNF (n=6) vs. patients without PNF (n=69) and found that the mean pump flow of donors during normothermic regional perfusion (NRP) was significantly lower in PNF patients versus non-PNF group (P=0.032).
Day 1 post-OLT levels of AST, ALT and the incidence of renal complications and postoperative mortality were also significantly higher in the PNF group, although the 5-year survival rate was similar in both groups (66.7% in PNF and 68.5% in non-PNF). All PNF patients underwent re-OLT.
Multivariate analysis confirmed that a final ALT value >4 times the normal value is a risk factor for PNF, whereas a median donor pump flow of >3,700 mL/min has a protective effect.
Our institution has experienced a decreased incidence of PNF in the last 5 years by following a protocol outlining adequate donor pump flow during NRP and only a moderate increase in ALT, which protects against PNF development in uDCD liver recipients.