Organ
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Primary non-function
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**Primary non-function (PNF) definition**: The transplanted organ never started working (properly)

**Date for PNF in 3LC**: Date of diagnosis of PNF by a physician. This might be days or weeks after transplantation. 

.. warning:: If the date of PNF is the same as the transplantation date, please set the date of the FUP and the PNF on the day after the transplantation and open a ticket and ask the Admin to change it to the transplantation date.

How to enter a PNF in 3LC
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1)	First set the toggle “graft loss”/ “End of transplant episode” in the FUP to yes.
2)	In allograft morbidities enter a graft-loss and enter the date of the graft loss.
3)	As cause of graft loss chose primary non-function and then in the drop-down list that appears enter the cause of the PNF.

Biopsies after a PNF or a graft loss
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Biopsies taken from the transplanted graft up to 6 weeks after a global event such as a primary non function or a graft loss should be entered in the system. 
Please add in the comment field that the date of the biopsy is after the organ loss.

Liver 
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Liver tumor staging
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When Liver tumor is confirmed as liver transplantation disease leading to transplantation the following sections are requested to be filled in:

* Liver tumor specification
* Tumor therapy
* Tumor staging at diagnosis
* Tumor staging at listing evaluation
* Tumor staging at pretransplant

.. note:: Existing data, as from old system, have been mapped into the new structure. So called historic variables, that used to be collected into the old system and are no longer collected are displayed with a grey backgroud, e.g. number of liver tumors based on imaging diagnosis, this to allow display of values entered in the old system. 

.. image:: LiverStaging1.png

Multiple therapy procedures can be entered by using the "+" button.

.. image:: LiverStaging2.png

Tumor staging related variables are collected at time of tumor diagnosis, if this information is not available then click on red button "missing" so the entire section will be set to "missing".

.. image:: LiverStaging3.png

Tumor staging related variables are collected at time of evaluation when patient is listed for transplantation, , if this information is not available then click on red button "missing" so the entire section will be set to "missing".

.. image:: LiverStaging4.png

Tumor staging related variables are collected before transplantation, , if this information is not available then click on red button "missing" so the entire section will be set to "missing".

.. image:: LiverStaging5.png

Clarification «Dindo‐Clavien grading»
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• The Dindo Clavien classification provides the grade severity of a complication, for example a postoperative bleed that does not require intervention is not the same as a postoperative bleeding requiring a blood transfusion that isn’t equal to one requiring re‐laparotomy and another ICU stay.

• Publishing data in which postoperative complications are included will always require for Dindo Clavien classification that are way easier to collect as part of the dataset rather than having to do so retrospectively.

.. Note:: 
   the classification is required to be collected for each reported complication related to liver transplantation.

The grading can be calculated by using the https://www.assessurgery.com/clavien-dindo-classification/ , or see screen-shot below.

.. image:: dindo_clavien.png

Pharmacological Treatment of Complications After Liver Transplantation
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In cases where a patient develops a complication such as an anastomotic biliary stricture (AS), resulting in severe symptoms like intense pruritus, pharmacological treatment may be initiated. Medications (e.g. cholestyramine or bezafibrate) can be prescribed to alleviate the symptoms.

This treatment should be documented in the **organ section** as ‘*pharmacological treatment*’ related to the complication ‘*Anastomotic biliary stricture (AS)*’.
(Discussed with N. Müller on 20.05.2025)

Kidney 
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Death after Graft loss in Kidney, Pancreas and Islets Transplantation
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In case of kidney, pancreas and/or islets transplantation, after a graft loss (glo no active organ) if you get the information that the patient died (e.g. from the dialysis register or a doctor), enter death with date and cause unknown in 3LC if there is no info available regarding the death.