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Vol. 99. Issue 5.
Pages 339-345 (May 2021)
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Vol. 99. Issue 5.
Pages 339-345 (May 2021)
Original article
DOI: 10.1016/j.cireng.2021.04.018
Is liver retransplantation justified in the current era?
¿Está justificado el retrasplante hepático en la era actual?
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Laura Lladó
Corresponding author
31513llg@comb.cat

Corresponding author.
, Josefina Lopez-Dominguez, Emilio Ramos, Alba Cachero, Kristel Mils, Carme Baliellas, Juli Busquets, Joan Fabregat
Unidad de Trasplante Hepático, Hospital Universitari de Bellvitge, IDIBELL, Barcelona, Spain
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Tables (2)
Table 1. Preoperative and operative characteristics depending on the type of retransplantation.
Table 2. Postoperative evolution depending on the type of retransplantation.
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Abstract
Introduction

Liver retransplantation (LRT) is a controversial indication. Our aim was to evaluate the rate of LRT at our institution, and to analyze its indications and short- and long-term results.

Methods

We conducted a retrospective study of a prospectively collected database, including 1645 LT from 1984 to 2018. Results have been analyzed depending on type of LRT (early vs. late), study period and indications.

Results

We performed 150 LRT in 140 patients. The LRT rate was 9%. Of these, 45 LRT were early (30%), and the other 70% were late LRT. The main indications were: ischemic cholangitis (27%), arterial thrombosis (19%), primary non-function (15%), and HCV recurrence (15%). Mean surgery duration (395 vs. 270 min; P = .001), cold ischemia time (435 vs. 390 min; P = .005) and transfused units required (8 vs. 5 RBC; P = .034) were higher in cases of late LRT. Postoperative mortality (10 vs. 20%; P = .01) was better in cases of late LRT. One- and 5-year actuarial survival rates were 71% and 58%, respectively, which were significantly better during the last decade (80% and 64%). Five-year actuarial survival for ischemic cholangitis is better than other indications, such as recurrence of HCV (78 vs. 51%; P = .02).

Conclusions

Liver retransplantation is complex and associated with high morbidity and mortality. However, indications and long-term results have improved during recent years. Therefore, LRT is justified.

Keywords:
Liver retransplantation
Ischemic cholangitis
Morbidity
Mortality
Survival
Resumen
Introducción

El retrasplante hepático (ReTH) es una indicación de TH controvertida. Nuestro objetivo fue determinar la tasa de ReTH y las indicaciones, morbilidad, mortalidad posoperatoria y supervivencia actuarial del paciente retrasplantado en nuestra serie.

Métodos

Estudio retrospectivo de una serie prospectiva de 1.645 pacientes trasplantados entre 1984 y 2018. Se analizan los resultados según el tipo de ReTH (precoz vs. tardío), periodo de estudio e indicaciones.

Resultados

Hemos realizado 150 ReTH en 140 pacientes. La tasa de ReTH fue de 9%. El 30% (45) de los ReTH fueron precoces, siendo tardíos el otro 70% (105). Las causas más frecuentes fueron: colangitis isquémica (27%), trombosis de la arteria hepática (19%), fallo primario del injerto (15%) y recidiva de la cirrosis por virus de la hepatitis C (VHC) (15%). La duración de la cirugía (395 vs. 270 min; p = 0,001), tiempo de isquemia (435 vs. 390 min; p = 0,005) y necesidad transfusional (8 vs. 5 CH; p = 0,034) fue mayor en los casos de ReTH tardío, mientras que la mortalidad posoperatoria (10 vs. 20%; p = 0,01) fue mejor en los casos de ReTH tardío. La supervivencia actuarial a uno y cinco años fue de 71% y 58%, respectivamente, con una mejoría significativa en la última década (80% y 64%). Por otra parte, la supervivencia en los casos de ReTH por colangitis isquémica es superior que otras indicaciones (78 vs. 51%; p = 0,02).

Conclusiones

El retrasplante es complejo y está asociado a una elevada morbimortalidad. Sin embargo, los resultados han mejorado en los últimos años por lo que su indicación está justificada.

Palabras clave:
Retrasplante hepático
Colangitis isquémica
Morbilidad
Mortalidad
Supervivencia

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