Early Recognition of Primary Liver Transplant Nonfunction

Following liver transplantation, it is important to identify nonfunction of the new liver, as early retransplantation is necessary.

Categories of liver function after transplant:

1) excellent function with modest elevations in transaminases, good bile production and rapid return of coagulation factors to normal levels

2) poor initial function, with subsequent improved function

3) nonfunctioning, with high mortality.

Test	Time after Opening of Portal Vein	Cutoff Limit
AST	4-6 hours	> 1500 IU/L
Factor 5	4-6 hours	< 20%
Prothrombin Time	4-6 hours	> 20 seconds

Test	Time after Opening of Portal Vein	Cutoff Limit
AST	24 hours	> 5000 IU/L
alkaline phosphatase (ALP)	24 hours	> 120 IU/L
Bile Production	24 hours	< 50 mL
Factor 5	24 hours	< 20%
Factor 8	24 hours	< 60%

Interpretation:

• If four or more of the above criteria are exceeded, then nonfunction is very likely.

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