Outcome
Indications for and Survival After Liver Retransplantation

https://doi.org/10.1016/j.transproceed.2010.02.017Get rights and content

Abstract

Introduction

Orthotopic liver retransplantation (re-OLT) is the therapeutic option for hepatic graft failures. Survival after re-OLT is poorer than after primary OLT. Given that there is an organ shortage, it is essential that we optimize our use of this scarce resource. We evaluated the results of re-OLT among 58 consecutive Re-OLT.

Materials and Methods

Using registry data from our Liver Transplantation Unit, we performed a retrospective cohort study of adult urgent versus elective re-OLT between 1991 and 2008. We recorded the indications for the initial OLT, and the intervals from OLT to re-OLT as well as age and gender. Using the Rosen model to stratify patients into low-intermediate-, and high-risk groups we calculated survivals.

Results

Among 661 adult liver transplantations, 56 patients (8.4%) underwent late re-OLT at a median of 654.4 days post-OLT. There were 17 (29%) urgent re-OLT and 41 elective cases (71%). Vascular complications were the most common cause of urgent re-OLT (64%); elective re-OLT was primarily due to chronic rejection (56.1%). Overall survival for retransplanted patients was significantly lower among urgent procedures (82.4% vs 48.8%), as well as for overall survival after re-OLT for patients with hepatitis C virus (HCV) versus other etiologies.

Conclusion

These data confirmed the utility of retransplantation in elective and emergency situations. Liver re-transplantation has a high morbidity and mortality. It requires multidisciplinary experience to decide inclusion and prioritization criteria for re-OLT, especially among patients with HCV.

Section snippets

Patients and Methods

We used registry data to perform a retrospective cohort study of adult liver retransplantations between 1991 and 2008, with a minimum follow-up of 6 months. Patients undergoing re-OLT neither utilized a living donor nor a split procedure. Furthermore, retransplant patient underwent a combined liver and kidney transplantation. We categorized re-OLT patients in 2 groups; urgent versus elective. We recorded the indication for the initial OLT; interval from OLT to re-OLT and outcomes. We analyzed

Results

The study population included 719 OLT including 58 (8.06%) re-OLT. Table 1 shows the baseline demographic, clinical, and biochemical characteristics of the patients undergoing re-OLT. The average age among patients with primary OLT was 50.7 years versus 49.4 in re-OLT. A greater percentage of men required re-OLT (67% vs 33%), but there was equal gender distribution among patients with primary OLT (64% vs 36%). We retransplanted 9.2% men versus 7.8% women. The mean donor age was 49.22 years. The

Discussion

We believe that re-OLT is the technique of choice for patients with a failed graft. The overall post re-OLT survival was significantly lower than that of non-retransplanted patients. When we analyzed the results of re-OLT, we differentiated between urgent and elective re-OLT, because of the differences in time interval, re-OLT causes, and patient survivals.

Overall post–re-OLT survival in this study was similar to that reported by the Spanish Liver Transplantation Registry (Registro Español de

References (19)

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