Elsevier

Transplantation Proceedings

Volume 41, Issue 6, July–August 2009, Pages 2441-2443
Transplantation Proceedings

Liver transplantation
Outcome
Short- and Long-Term Overall Results of Liver Retransplantation: “Doce de Octubre” Hospital Experience

https://doi.org/10.1016/j.transproceed.2009.06.045Get rights and content

Abstract

Introduction

The liver retransplantation rate in Spain is about 6%. The main causes are primary nonfunction, vascular complications, chronic rejection, and recurrent liver disease. The results of this procedure are worse than those of first transplantations.

Patients and Methods

This retrospective study evaluated our experience with 54 retransplantations performed between January 1992 and December 2006, which were 5.6% of the 960 orthotopic liver transplantations (OLT) during this period.

Results

In this study, 34.7% of the retransplantations were performed between 4 and 30 days after the first transplantation; another 34.7% were within 1 year. Also, 48.9% of the retransplantations were performed in urgent situations. The main causes for retransplantation during the first month were primary hepatic failure (n = 14) and vascular complications (n = 4). After the first month the main causes were chronic rejection (n = 9), recurrence of hepatic disease (n = 3), and biliary complications (n = 4). Postoperative mortality was 23.9% and morbidity was 76.3%. However, 21.2% of the patients needed a third transplant. The overall rate of patient survival was 60.4% (n = 32) and of graft survival was 56.6% (n = 30). The 5-year actuarial graft survival rate was 65.4% with a mean survival time of 89.84 ± 8.72 months; the 5-year patient survival rate was 64% with a mean survival time of 114.7 ± 12.53 months. Worse survival was observed in chronic rejection and in retransplantations performed between 31 and 360 days.

Conclusions

Liver retransplantation presents greater surgical complexity than the first transplantation, but is a good option for patients with failure of the first graft with a 5-year patient and graft survival rate greater than 65%.

Section snippets

Patients and Methods

From January 1992 to December 2006, we performed 960 orthotopic liver transplantations (OLT), including 54 liver retransplantations (5.6%). We included all adult patients with a liver retransplantation, excluding children and retransplantations outside of these dates. The mean patient age was 48.7 ± 12.4 years with 70.4% men. The main etiology was hepatitis C virus (HCV) cirrhosis (27.8%) or alcoholic cirrhosis (22.2%).

This retrospective study analyzed the results using SPSS for Windows v 15.0.

Results

The mean time between the first and the second transplantation was 2593 ± 1382 days with a median of 74 days. In this study, 34.7% of the retransplantations were performed at 4–30 days after the first one with the other 34.7% within 1 year after; namely, 18.4% between 31 and 360 days and only 12.2% in the first 3 days. Also, 48.9% of the retransplantations were performed in urgent situations.

The main cause for retransplantation during the first month was primary nonfunction (n = 14) or vascular

Discussion

The incidence of retransplantation during the last 14 years in our Department was 5.6%, which differed from other reports in the literature showing 10%–20%.1, 2, 3, 4, 5, 6, 7 Like others, the main cause for retransplantation was primary nonfunction followed by chronic rejection, but we noted a lower rate of patients with vascular complications. In our experience the main surgical complications were bleeding and abdominal wall complications, differing from the publication of Tzakis et al,25

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