A Multicenter Japanese Survey Assessing the Long-term Outcomes of Liver Retransplantation Using Living Donor Grafts

Abstract

Background. Liver transplantation is the most suitable treatment option available for end-stage liver disease. However, some patients require retransplantation, despite medical advances that have led to improved survival. We aimed to compile a definitive, nationwide resource of liver retransplantation data in Japan, seeking to identify the predictors of patient survival posttransplantation. Methods. Questionnaires were sent to 32 institutions that had conducted 281 retransplantations before 2015. Results. Among the 265 patients included in this study (142 pediatric cases), the average age at primary transplantation was 23 years, and retransplantation was performed after an average of 1468 days. The main indication for retransplantation was graft rejection (95 patients). Living-donor liver transplantation accounted for 94.7% of primary transplantations and 73.2% of retransplantations. Patient survival at 1, 3, or 5 years did not differ by type of transplantation but was better for pediatric (70.8%, 68.3%, and 60.1%, respectively) than for adult (57.2%, 50.4%, and 45.2%, respectively) recipients (P = 0.0003). Small-for-size syndrome, retransplantation within 365 days, and inpatient status at retransplantation were significant predictors of poor survival in pediatric cases. Retransplantation within 365 days and conditions warranting retransplantation were significant predictors of poor survival in adult patients. Conclusions. In Japan, where >70% of retransplantations are performed using living donors, the indications and timing are different from those in previous reports from other countries, while maintaining comparable survival rates. Considering technical challenges, graft failure within 365 days should be thoroughly restricted to justify the use of living donor.

Liver Retransplantation Using Living Donor Grafts: A Western Experience

“…(9) In a nationwide retrospective survey from Japan, 123 adult liver and 142 pediatric liver retransplants were performed before 2015, of which living donor grafts were used in 194 (73%) patients. (10) The main indication for retransplantation was chronic rejection or disease recurrence, leading to a long average time interval of 1468 days between the first and second transplants. (10) Risk factors for worse outcomes included MELD scores >25, hospitalization at the time of retransplantation, and a time interval <365 days since the primary transplant.…”

“…(10) The main indication for retransplantation was chronic rejection or disease recurrence, leading to a long average time interval of 1468 days between the first and second transplants. (10) Risk factors for worse outcomes included MELD scores >25, hospitalization at the time of retransplantation, and a time interval <365 days since the primary transplant. (10) As summarized by Au et al, successful LDLT in high-risk recipients requires the following 3 essential elements: (1) recognition of futility, (2) an optimized graft, and (3) experience.…”

Association between hospital liver transplantation volume and mortality after liver re-transplantation

“…The similar in-hospital mortality after liver re-transplantation between the high and low-volume centers in our study may partly be explained by the higher proportion of early liver re-transplantation in the low-volume centers compared to the high volume centers. The difference in outcome between early and late liver re-transplantation are still controversial as some studies suggest that early re-transplantation is associated with better survival [ 37 , 38 ], whereas others report that late re-transplantation may result in better outcome [ 17 ].…”

Living donor liver transplantation-associated retransplantation in adult patients

“…In the United States of America, a study using Adult to Adult Living Donor Liver Transplantation Study (A2ALL) data collected between 1998 and 2014 revealed that 110 recipients (10.3%) of 1,065 patients underwent retransplantation, in which hepatitis C virus infection, longer length of stay, hepatic artery thrombosis, biliary stricture, infection, and disease recurrence were associated with increased risk of retransplantation [1]. In a Japanese multicenter study, 7,937 liver transplants had been performed at 67 institutions by the end of 2014, with 7,673 LD and 264 DD liver transplants [2]. First transplantation was performed in 7,682 patients (96.8%), second transplantation in 242 patients (3.0%), and third transplantation in 13 patients (0.2%) [2].…”

“…In a Japanese multicenter study, 7,937 liver transplants had been performed at 67 institutions by the end of 2014, with 7,673 LD and 264 DD liver transplants [2]. First transplantation was performed in 7,682 patients (96.8%), second transplantation in 242 patients (3.0%), and third transplantation in 13 patients (0.2%) [2].…”