Early graft dysfunction

Hyperacute rejection rarely occurs in patients receiving a liver transplant. The liver s special status for transplantation is not fully understood, but the local release of cytokines may alter the immunologic reaction taking place in the liver. Early graft dysfunction is treated with supportive care and retransplantation if possible. 

Complications in the acute phase occur in a time window between the first few hours and 3 months after transplantation. Usually patients are extubated within 24-48 h of transplantation. The intubation time can be prolonged and a tracheostomy may be necessitated if a complication such as early graft dysfunction or infection arises. 

Early graft dysfunction (EGD) is defined as a clinical scenario that includes radiographic abnormalities. 

Despite improvements in organ preservation and perioperative management, ischemia reperfiision injury remains the most common cause for morbidity and mortality within the first month of lung transplantation (26,27). Severe early graft dysfunction results from increased pulmonary vascular permeability and alveolar type II cell dysfunction (28-30). Histologically, there is difiuse alveolar damage as well as organizirrg pneumonia (31,32). 

Severe hypertension with or without allograft dysfunction is the most frequent clinical symptom. Hypertension is a common feature in transplant recipients (up to 80%). Therefore, as for native kidneys, RAS is specifically suspected when hypertension develops suddenly, rapidly becomes more severe and resistant to medical therapy, and is associated with graft dysfunction without any other cause or when associated with an audible bruit over the graft (Palleschi et al. 1980 Rijksen et al. 1982). It may account for around l%-5% of post-transplant hypertension. However, at present, early RAS are often detected systematically with color flow US, despite no blood pressure or renal function change. 

Early postoperative complications include primary graft non-function, primary graft dysfunction, vascular, infectious, biliary, and immunological complications (Table 4.1.4). Early graft failure otherwise known as primary graft non-function is relatively... 

Thrombosis of the vascular access is a major problem in chronic HD. Although thrombosis occurs in grafts, and to a lesser extent Hs-tulas, thrombosis associated with catheters is the most problematic and will be the focus of discussion here. Early dysfunction (less than 5 days after placement) of an HD catheter is usually associated with an intracatheter or catheter-tip thrombosis, or a malpositioned catheter. Thrombi that occur after approximately 1 week can be outside the catheter (extrinsic) or within the catheter (intrinsic). Intrinsic throm-... 

In addition, patients who achieved immediate postoperative graft function may also develop renal dysfunction early during the course of OKT3 prophylaxis. Indeed, 10 out of 133 patients (7.5%) treated with OKT3, azathioprine and steroids experienced an abrupt rise in serum creatinine between postoperative days 2 to 5. None of these patients had received cyclosporine. Six patients underwent allograft biopsies at the time of dysfunction 4 were normal, and 2 showed only mild interstitial edema. All patients recovered without sequelae. This side effect was considered related to the cytokines released after OKT3 therapy [114]. 

---