Results of Early Liver Retransplantation (original) (raw)

Long-Term Survival After Retransplantation of the Liver

Annals of Surgery, 1997

The authors determined the long-term outcome of patients undergoing hepatic retransplantation at their institution. Donor, operative, and recipient factors impacting on outcome as well as parameters of patient resource utilization were examined. Summary Background Data Hepatic retransplantation provides the only available option for liver transplant recipients in whom an existing graft has failed. However, such patients are known to exhibit patient and graft survival after retransplantation that is inferior to that expected using the same organs in narive recipients. The critical shortage of donor organs and resultant prolonged patient waiting periods before transplantation prompted the authors to evaluate the results of a liberal policy of retransplantation and to examine the factors contributing to the inferior outcome observed in retransplanted patients. Methods A total of 2053 liver transplants were performed at the UCLA Medical Center during a 13year period from February 1, 1984, to October 1, 1996. A total of 356 retransplants were performed in 299 patients (retransplant rate = 17%). Multivariate regression analysis was performed to identify variables associated with survival. Additionally, a case-control comparison was performed between the last 150 retransplanted patients and 150 primarily transplanted patients who were matched for age and United Network of Organ Sharing (UNOS) status. Differences between these groups in donor, operative, and recipient variables were studied for their correlation with patient survival. Days of hospital and intensive care unit stay, and hospital charges incurred during the transplant admissions were compared for retransplanted patients and control patients. Results Survival of retransplanted patients at 1, 5, and 10 years was 62%, 47%, and 45%, respectively. This survival is significantly less than that seen in patients undergoing primary hepatic transplantation at the authors' center during the same period (83%, 74%, and 68%). A number of variables proved to have a significant impact on outcome including recipient age group, interval to retransplantation, total number of grafts, and recipient UNOS status. Recipient primary diagnosis, cause for retransplantation, and whether the patient was retransplanted before or after June 1, 1992, did not reach statistical

Incidence of Liver Retransplantation and Its Effect on Patient Survival

Transplantation Proceedings, 2008

The purpose of this study was to review our institutional experience with re–liver transplantation (OLT) after split and full-size OLT.We evaluated data corresponding to retransplanted patients over an 8-year period who underwent deceased donor OLT at our institution. Variables analyzed included indications for primary OLT, and re-OLT, the type of graft used during the initial versus re-OLT, the time from initial to re-OLT, and patient survival after re-OLT.Sixty-four of 697 first OLT (9.2%) required re-OLT. Forty-nine cases were among 637 (7.6%) full-size OLT, while 15 were among 60 (25%) split OLT (P < .001). Median time to re-OLT was 8 days (range = 1–1885 days). Main indications for re-OLT were primary nonfunction/initial poor function (44%), hepatic artery thrombosis (26%), biliary complications (11%), and hepatitis C recurrence (6%). Forty-eight percent of the re-OLTs were performed within the first posttransplant week. The overall survival for these 64 patients was 55% and 48% at 1 and 3 years after the primary OLT, and 44% at both 1 and 3 years after the re-OLT, respectively.The overall incidence of re-OLT remains 9%. Approximately half of all re-OLT occured within the first posttransplant week. Early retransplantation was associated with the best patient survival. Overall survival after re-OLT was about 10% to 20% lower than that after primary OLT.

Decision for Retransplantation of the Liver

Annals of Surgery, 2002

To determine the patient factors affecting patient outcome of first liver retransplantation at a single center to help in the decision process for retransplantation. Summary Background Data Given the critical organ shortage, one of the most controversial questions is whether hepatic retransplantation, the only chance of survival for patients with a failing first organ, should be offered liberally despite its greater cost, worse survival, and the inevitable denial of access to primary transplantation to other patients due to the depletion of an already-limited organ supply. The authors' experience of 139 consecutive retransplantations was reviewed to evaluate the results of retransplantation and to identify the factors that could improve the results. Methods From 1986 to 2000, 1,038 patients underwent only one liver transplant and 139 patients underwent a first retransplant at the authors' center (first retransplantation rate ϭ 12%). Multivariate analysis was performed to identify variables, excluding intraoperative and donor variables, associated with graft and patient longterm survival following first retransplantation. Lengths of hospital and intensive care unit stay and hospital charges incurred during the transplantation admissions were compared for retransplanted patients and primary-transplant patients.

Risk factors for death following liver retransplantation

Transplantation Proceedings, 2003

Aim. Our goal was to retrospectively analyze graft loss and mortality risk factors using multi-centre data on liver retransplantation. Material and methods. Between 1991-1995, 640 patients underwent 718 liver transplants in Barcelona. Mean age of the 74 patients receiving a second transplant was 47.6 years (range 19-65). Causes of retransplantation were immunologic in 26 patients (35.1%), technical in 23 (31.1%), primary dysfunction in 12 (16.2%), recurrent original disease in 7 (9.5%), and other causes in 6 (8.1%). Mean time between first and second transplant was less than 7 days in 20 patients (27%), between 8 and 30 days in 4 (5.4%) and more than 30 days in 50 patients (67.6%). Recipient, donor, and operative variables were analyzed using univariate (Kaplan-Meier curves) and multivariate techniques (Cox regression) to identify risk factors. Results. Retransplant patient survival at 1 and 5 years was 60.8% and 49.5%, respectively, compared to 75.6% and 64.8% in a series of 640 first transplant patients. Mortality risk factors identified by multivariate analysis were bilirubin Ͼ12 mg/dL (RR 2.3; P ϭ .010), recipient age (RR increase 0.04 for each additional year; P ϭ .02), cause for retransplant (immunologic RR 4.01, technical RR 2.7 and other causes RR 6.9; compared to primary dysfunction RR 1; P ϭ .020). Urea Ͼ54 mg/dL (0.02) and multiple transfusions Ͼ15 units red blood cells (0.001) were only significant in the univariate analysis. Conclusions. In our experience, retransplantation for primary dysfunction is the setting that has the best prognosis. Of the other causes, retransplantation should be performed before the total bilirubin reaches Ͼ12 mg/dL or before the appearance of variables indicative of severe renal insufficiency.

Retransplantation for end-stage liver disease: a single-center Asian experience

2008

Liver retransplantation carries a significantly higher morbidity and mortality compared with patients after single transplantations. The aim of this study was to review our outcomes in liver retransplantations. From February 1984 to February 2007, 409 liver transplantations were performed on 396 patients, including 13 retransplantations (3.2%) in 12 patients. The mean follow-up was 1.6 Ϯ 0.4 years (range, 0.1-5.2). The mean duration between the first and the second transplantation was 2.8 Ϯ 1.0 years (range, 15 days-11.6 years). The indications for the first liver transplantation included biliary atresia (n ϭ 3), hepatitis B virus (HBV)-related cirrhosis with hepatoma (n ϭ 3), fulminant hepatic failure (n ϭ 2), HBV-related end-stage liver disease (n ϭ 1), hepatitis C virus (HCV)-related end-stage liver disease (n ϭ 1), neonatal hepatitis (n ϭ 1), and glycogen storage disease (n ϭ 1). The indications for retransplantations were secondary biliary cirrhosis (n ϭ 3), veno-occlusive disease-related liver failure (n ϭ 2), hepatic arterial occlusion and graft failure (n ϭ 2), chronic rejection with hepatic graft failure (n ϭ 2), recurrent HBV (n ϭ 1) and de novo HBV-related decompensated cirrhosis (n ϭ 1), and idiopathic graft failure (n ϭ 1). There were 4 living donor and 9 deceased donor liver retransplantations. The cumulative survival rate was 71.4 Ϯ 14.4%, with an estimated mean survival time of 3.9 Ϯ 0.7 years. Our results showed that minimizing the rate of retransplantation was critical to enhance overall patient survival. Moreover, living donor liver retransplantation is another option within the short, yet critical, waiting period, after failure of the first graft. Provided that a suitable living donor is available, we recommend early retransplantation to minimize the risk of morbidity and mortality.

Significant influence of the primary liver disease on the outcomes of hepatic retransplantation

Irish Journal of Medical Science, 2008

Background There are many indications for hepatic retransplantation. Aim To identify factors influencing retransplantation needs and outcomes. Patients and methods Retransplantation records from January 1993 to March 2005 were analysed. Patient and disease characteristics and survival outcomes for retransplantation were compared between various groups. Results Totally, 286 primary and 42 hepatic retransplantations were performed. Retransplantation indications included primary sclerosing cholangitis (PSC), primary biliary cirrhosis, chronic hepatitis C (HCV), chronic active hepatitis (CAH), and alcohol-related disease. Mean followup post-retransplantation was 31 ± 9 months. Actuarial patient survival at 3 months, 1 year, 3 years, 5 years, and at the end of study was 71.4, 69, 59.5, 54.7, and 50%, respectively. Early and late retransplantation had 1-year survival of 73 and 68.5%, respectively. Retransplantation need was significantly higher for PSC, HCV, and CAH. Conclusions Hepatic retransplantation remains a successful salvage option for transplant complications; however, its need is significantly influenced by the primary liver disease.