Liver retransplantation: Recurrent primary sclerosing cholangitis may provide better outcomes (original) (raw)

2017, Liver Transplantation

Graft failure occurs in up to 27% of adult patients in the first year after liver transplantation and up to 36% by 5 years. (1,2) Retransplantation is the only curative option after graft failure, but both graft and patient survival are significantly worse following retransplantation. (1,3-6) The question of how to best use retransplantation raises technical, economic, and ethical questions, all of which suffer from a paucity of published data on retransplantation trends and outcomes. Graft failure leading to retransplantation can occur early (1 month after primary transplantation) or late (>1 month after primary transplantation), although the time point that separates the two is not well defined. (1,2,4,6) Early graft failure is caused by primary nonfunction or vascular complications, whereas late graft failure has a variety of etiologies including chronic rejection and recurrence of primary disease. (2) Early graft failure is severe, making the decision to retransplant straightforward. Early retransplantation surgery is typically easier than initial transplant with less dissection during recipient hepatectomy. By contrast, late graft failure is more insidious. With current organ allocation, candidates for retransplantation must have advanced hepatocellular failure often complicated by renal failure in addition to the adverse consequences of chronic immunosuppression. Compounding these Abbreviations: ICU, intensive care unit; MELD, Model for End-Stage Liver Disease; PSC, primary sclerosing cholangitis.