Introduction

Outcome following transplantation is directly related to the quality of organs procured. Poor graft function following abdominal organ transplantation results in increased patient morbidity and mortality. Following renal transplantation, poor graft function is known as transplant acute tubular necrosis or ATN. This term is borrowed from the syndrome of acute renal failure occurring as a result of a number of different causes, such as hypovolemic shock and crush injuries, where classic renal morphologic changes are seen on microscopy. Posttransplant ATN is remarkable for the paucity of histological changes. Fortunately for most patients, posttransplant ATN resolves and unlike the nontransplant variety rarely leads to renal failure.

Following liver transplantation, poor hepatic graft function may range from primary nonfunction to persistent enzyme abnormalities. Histological analysis of the transplanted liver may show areas of extensive hepatocyte necrosis and bile duct damage. For both primary nonfunction and livers with significant microscopic abnormalities and poor function, retransplantation is required with

Organ Procurement and Preservation, edited by Goran B. Klintmalm and Marlon F. Levy. © 1999 Landes Bioscience significant risk for increased morbidity and mortality. Following pancreatic transplantation, poor function may be manifest as posttransplant allograft pancreatitis or failure to achieve insulin independence.

In our current era of cost containment and managed care, transplant professionals are acutely aware that poor graft function, in addition to increasing morbidity and mortality, substantially increases the costs of transplantation by leading to longer hospital stays, increasing medication costs, necessitating dialysis and in some cases leading to retransplantation. As transplant programs are coming under increasing public and governmental scrutiny and oversight, every effort must be made to minimize morbidity and mortality and to contain costs. Poor graft function results from any number of insults sustained by the organ from the moment of injury leading to brain death, during organ donor management, during the procurement process and finally during the transplant procedure itself. This chapter will focus on the optimal management of the abdominal organ donor. Optimal donor management and avoidance of organ injury will significantly minimize posttransplant graft dysfunction.

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