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 hepatocellular 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 (4386 +/- 546 U/L to 102 +/- 21 U/L), prothrombin time (22 +/- 2 to 12 +/- .4 sec) and partial thromboplastin time (45 +/- 3-29 +/- 4 sec), 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 survival was 80% in the PGE1-treated group and 17% in the untreated group (P less than 0.05) and patient survival was 90% and 33%, respectively. This study suggests a potential benefit of
PGE1 in the treatment of primary nonfunction.