Primary Nonfunction (PNF) in the MELD Era: An SRTR Database Analysis
Article first published online: 7 FEB 2007
American Journal of Transplantation
Volume 7, Issue 4, pages 1003–1009, April 2007
How to Cite
Johnson, S.R., Alexopoulos, S., Curry, M. and Hanto, D.W. (2007), Primary Nonfunction (PNF) in the MELD Era: An SRTR Database Analysis. American Journal of Transplantation, 7: 1003–1009. doi: 10.1111/j.1600-6143.2006.01702.x
- Issue published online: 7 FEB 2007
- Article first published online: 7 FEB 2007
- Received 12 August 2006, revised 21 November 2006 and accepted for publication 6 December 2006
- Graft failure;
- liver transplant;
- primary nonfunction
PNF following liver transplantation (LT) is an infrequent but life-threatening complication. Liver allocation under MELD is based upon recipient severity of illness, a known risk factor for the occurrence of PNF. The incidence of PNF since the application of MELD has not previously been reported. The SRTR database was studied since inception of MELD until September 2004 for all adult recipients of deceased donor LT. PNF was defined as graft loss or death within 14 days of LT secondary to PNF or without defined cause.
A total of 10545 transplants met inclusion criteria and PNF occurred in 613 (5.81%) of recipients. Univariate analysis demonstrated donor age, serum creatinine >1.5 mg/mL, hypertension and CVA as risk factors for PNF. Recipient factors included life support, mechanical ventilation, use of inotropes, hemodialysis, initial status 1 and use of a shared transplant. In the multivariate model only donor age and recipient serum creatinine, bilirubin, on life support and status 1 at transplant were significant risk factors for PNF.
In this analysis of PNF in the MELD era the incidence of PNF does not appear to have increased from prior reports. Risk factors for PNF are related to donor age and severity of recipient illness.