Chen Xiao-Bo, Xu Ming-Qing
Department of Liver and Vascular Surgery, West China Hospital, Sichuan University, Chengdu 610041, China.
Hepatobiliary Pancreat Dis Int. 2014 Apr;13(2):125-37. doi: 10.1016/s1499-3872(14)60023-0.
Primary graft dysfunction (PGD) causes complications in liver transplantation, which result in poor prognosis. Recipients who develop PGD usually experience a longer intensive care unit and hospital stay and have higher mortality and graft loss rates compared with those without graft dysfunction. However, because of the lack of universally accepted definition, early diagnosis of graft dysfunction is difficult. Additionally, numerous factors affect the allograft function after transplantation, making the prediction of PGD more difficult. The present review was to analyze the literature available on PGD and to propose a definition.
A search of PubMed (up to the end of 2012) for English-language articles relevant to PGD was performed to clarify the characteristics, risk factors, and possible treatments or interventions for PGD.
There is no pathological diagnostic standard; many documented definitions of PGD are different. Many factors, such as donor status, procurement and transplant process and recipient illness may affect the function of graft, and ischemia-reperfusion injury is considered the direct cause. Potential managements which are helpful to improve graft function were investigated. Some of them are promising.
Our analyses suggested that the definition of PGD should include one or more of the following variables: (1) bilirubin ≥ 10 mg/dL on postoperative day 7; (2) international normalized ratio ≥ 1.6 on postoperative day 7; and (3) alanine aminotransferase or aspartate aminotransferase >2000 IU/L within 7 postoperative days. Reducing risk factors may decrease the incidence of PGD. A majority of the recipients could recover from PGD; however, when the graft progresses into primary non-function, the patients need to be treated with re-transplantation.
原发性移植肝无功能（PGD）可引发肝移植术后并发症，导致预后不良。与未发生移植肝无功能的受者相比，发生PGD的受者通常在重症监护病房和医院的住院时间更长，死亡率和移植肝丢失率更高。然而，由于缺乏普遍接受的定义，移植肝无功能的早期诊断较为困难。此外，众多因素会影响移植术后的移植物功能，使得PGD的预测更加困难。本综述旨在分析有关PGD的现有文献并提出一个定义。
检索了PubMed（截至2012年底）中与PGD相关的英文文章，以阐明PGD的特征、危险因素以及可能的治疗方法或干预措施。
尚无病理诊断标准；许多已记录的PGD定义各不相同。许多因素，如供体状况、获取和移植过程以及受者疾病等，都可能影响移植物功能，而缺血再灌注损伤被认为是直接原因。研究了有助于改善移植物功能的潜在管理方法。其中一些颇具前景。
我们的分析表明，PGD的定义应包括以下一个或多个变量：（1）术后第7天胆红素≥10mg/dL；（2）术后第7天国际标准化比值≥1.6；（3）术后7天内丙氨酸转氨酶或天冬氨酸转氨酶>2000IU/L。降低危险因素可能会降低PGD的发生率。大多数受者可从PGD中恢复；然而，当移植物发展为原发性无功能时，患者需要接受再次移植治疗。
