Primary liver graft dysfunction and non-function: integrative literature review.

Márcia Eller Miranda Salviano,Isadora Soto Tonelli,Tânia Couto Machado Chianca,Hérica Pinheiro Correa,Agnaldo Soares Lima

doi:10.1590/0100-6991e-20192039

Márcia Eller Miranda Salviano, Isadora Soto Tonelli + Show 3 more

Open Access

https://doi.org/10.1590/0100-6991e-20192039

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Abstract

Avoiding deaths in the waiting list for an organ is no longer the only focus of the transplant teams attention. Research and care in clinical practice has been increasingly focused on post transplant graft survival and functioning. In the present work, we performed an integrative literature review to identify the terminology used about liver graft dysfunction and non-function, as well as to investigate the incidence and risk factors of these clinical events. We chosen articles written in Portuguese, English and Spanish between 2012 and 2016, based on CINAHL, MEDLINE, Cochrane, LILACS, BDENF, IBECS, EMBASE and Web of Science. We selected 14 studies, in which we identified the incidence of hepatic graft dysfunction ranging from 7% to 27%. The terminology used to describe this clinical event was initial malfunction, graft hypofunction, marginal function or delay in function. The primary non-function of the liver graft was found in 1.4% to 8.4% of the patients, and the terminology used to describe the event was early dysfunction or graft loss. The risk factors found are related to donor, recipient, graft and transplant logistics variables. We conclude that knowledge of the different terminologies employed in the literature, related to dysfunction and primary non- function incidence, and of their risk factors are fundamental to qualify the control of the events, aiming to improve patients' survival after liver transplantation.

Highlights

The most feared event by transplant surgeons is the graft non-functioning after implant[1,2,3,4,5,6]
This study identified the nomenclatures used in the literature, the incidence and risk factors associated with Early graft dysfunction (EGD) and primary nonfunction (PNF)
The present Integrative Literature Review (ILR) had some limitations, such as the fragility of the evidences of the identified articles and the lack of a standardized language referring to the subject, with a great variation of descriptors, which made the selection of the studies difficult

Summary

Introduction

The most feared event by transplant surgeons is the graft non-functioning after implant[1,2,3,4,5,6]. To describe this condition, the literature uses different nomenclatures, especially in the case of liver transplantation[7]. Liver transplant initiates with removal of the liver to be donated, followed by preparation of the graft and ending with the implant in the recipient. When the aortic artery is unclamped in the recipient and the liver is reperfused, the so-called ischemiareperfusion lesion occurs at the tissue and cellular levels. After 14 hours of cold ischemia, this lesion is much more severe, and may contribute to the early graft failure

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