Plasmapheresis in primary dysfunction of hepatic transplants

Background: Primary dysfunction is a failure of graft function which occurs in approximately 5% of transplanted livers. Retransplantation is often required. The presence of elevated serum cytokines interleukin 6 and tumor necrosis factor with hepatic graft dysfunction, as well as the historical benefit of plasmapheresis in fulminant hepatic failure-associated coma suggest a possible role for plasmapheresis therapy in the management of primary graft dysfunction in liver transplantation. Design and Methods: We evaluated the effectiveness of plasmapheresis in the management of primary graft dysfunction in 18 patients who underwent orthotopic liver transplantation in this institution. Patients who were diagnosed with primary dysfunction of hepatic grafts underwent a course of four daily plasma exchange procedures. The clinical outcome, patient and graft survival, was compared to that of historical controls. Results: Graft survival at 10 days was 77.7% and 76.2% and patient survival at 100 days was 83.3% and 85.7% in the plasmapheresed and control groups, respectively. The patients who underwent plasmapheresis had a higher incidence of dialysis intervention, 38% versus 19%, indicating more severe graft dysfunction. In the small number of patients compared for concomittant dialysis therapy, patient survival in the plasmapheresed group was 85.7% versus 50% (control), and graft survival was 57.0% versus 50%. Serum cytokine levels of tumor necrosis factor and interleukin 6 were reduced by 66.0% and 55.2%, respectively, with a single procedure. Conclusion: Plasmapheresis did not significantly effect graft survival in patients with primary graft dysfunction. An increase in patient survival in severe graft dysfunction with renal failure was noted but was not significant. Removal of elevated serum cytokines TNF and IL-6 was documented.