Early graft dysfunction is an important cause of morbidity and mortality. Primary non-function of the graft requires urgent retransplantation. Causes include complete vascular occlusion, ischemia, necrosis or reperfusion injury, or prior disease of the donor liver. It should be distinguished from reversible early graft dysfunction caused by an inadequate vascular anastomosis, acute rejection, and sepsis in the recipient. Clinical features of graft failure include hemodynamic instability similar to sepsis (a low systemic vascular resistance syndrome), reduced bile production, a metabolic (predominantly lactic) acidosis, increasing prothrombin time, persistent hypoglycemia requiring intravenous glucose support, and progressive multiple organ failure.
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