TREATMENT OF PRIMARY LIVER GRAFT NONFUNCTION WITH PROSTAGLANDIN E1

Abstract

Primary nonfunction following orthotopic liver transplantation is characterized by rapidly rising serum transaminases, minimal bile production, and severe coagulopathy, which can progress to hypoglycemia, hepatic encephalopathy, and acute renal failure. Untreated it has a mortality of over 80% and to date the only treatment has been retransplantation. As a result of the beneficial effect of Prostaglandin E₁ infusion in patients with fulminant hepatic failure, this trial was conducted to determine whether PGE₁ would be of value in primary nonfunction. We have encountered 16 cases of primary nonfunction in 94 liver transplants, an incidence of 17%. Initially in the program, there were 6 occurrences of nonfunction that did not receive PGE₁; 3 underwent retransplantation (2 survivors), 2 died awaiting another liver, and in one recovery of hepato-cellular function occurred with supportive care but the patient died of cytomegalovirus infection. Ten patients received PGE₁ within 4–34 hr of transplantation. Within 12 hr of treatment, 8 patients responded with a significant fall in the AST (129 U/hr) whereas, in the untreated group, the AST continued to rise (267±102 U/hr) at the same rate as prediagnosis (337±95 U/hr). At the conclusion of the infusion (4–7 days) in the 8 responders, there were significant decreases in AST (7386±546 U/L to 102±21 U/L), prothrombin time (22±2 to 12±.4 sec) and partial thromboplastine time (45±329±4 saec), and significant increases in coagulation factor V (26±8 to 95±12%) and factor VII (10±5 to 61±4%). No serious side effects occurred, although 2 patients developed diarrhea, and abdominal cramps. Two patients treated with PGE₁ were retransplanted at 10–36 hr and were considered nonresponders. Graft suvival was 80% in the PGE₁-treated group and 17% in the unteated group (P1 in the treatment of primary nonfunction.