How to define initial poor graft function after liver transplantation? - a new functional definition by the LiMAx test

Initial poor function (IPF) is a frequent complication after liver transplantation, but there is no consensus on its definition. Ninety-nine patients undergoing primary deceased-donor liver transplantation were examined in a prospective clinical trial. A new functional classification for initial graft function was developed based on two LiMAx readouts during 24 h after transplantation with a cutoff LiMAx of 60 and 120 μg/kg/h using a simple algorithm. Patients were classified as non- (3/99), poor- (23/99) and immediate function (73/99). The functional regeneration of IPF grafts was delayed until day 28 (P < 0.05). Significant differences were observed for postoperative maximal transaminase activity, bilirubin, albumin, coagulation and creatinine. Recipients' MELD score, the donor risk index and donor age were increased in the IPF group. Incidence of haemodialysis (P = 0.003) and catecholamine support (P < 0.0001) was higher for IPF, resulting in higher therapy costs (P = 0.049). However, IPF did not influence either the length of stay (P = 0.434) or 2-year recipient (P = 0.415) or graft survival (P = 0.495). In conclusion, the LiMAx test might provide the first adequate functional parameter to assess and classify liver graft performance from the beginning. Patients with IPF frequently suffer from secondary complications, but ultimately develop satisfactory outcome and thus worth intensive and expensive therapy.