Analysis of Long-term Outcomes of 3200 Liver Transplantations Over Two Decades

Busuttil, Ronald W.; Farmer, Douglas G.; Yersiz, Hasan; Hiatt, Jonathan R.; McDiarmid, Sue V.; Goldstein, Leonard I.; Saab, Sammy; Han, Steven; Durazo, Francisco; Weaver, Michael; Cao, Carlos; Chen, Tony; Lipshutz, Gerald S.; Holt, Curtis; Gordon, Sherilyn A.; Gornbein, Jeff; Amersi, Farin; Ghobrial, Rafik M.

doi:10.1097/01.sla.0000164077.77912.98

Cited by 375 publications

(325 citation statements)

References 42 publications

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“…The days of hospitalization and ICU stay have changed from an earlier study, 27 but were similar to a more recent study. 27 About half the patients were in the hospital at the time of reTX, with only a few in the ICU or on mechanical ventilation.…”

Section: Discussionsupporting

confidence: 66%

“…18,[21][22][23] The reported ability of MELD scores to predict post-reTX survival has been variable. 9,[24][25][26][27] In our study, although MELD scores were not predictive of post-reTX survival, higher MELD scores (particularly Ͼ25) at the time of reTX were associated with high post-reTX mortality. Overall post-reTX patient survival at 3 yr was 40 to 56% for patients with HCV infection regardless of MELD scores, whereas in non-HCV patients, the survival at 3 yr was below 60% only when the MELD score was above 30 (survival was 37%).…”

Section: Discussioncontrasting

confidence: 60%

“…Those retransplanted within 1 yr of initial transplant had poorer survival (3-yr survival, 46%). Other studies have found many variables that may contribute to poorer survival including recurrent HCV, 14 ChildTurcotte-Pugh score, 25 hepatic encephalopathy, 25 intensive care stay, 14,28 poor renal function, 14,19,20,22,25,29,30 donor age, 11,14,17,20,27 prothrombin time, 11,20,25 time interval from initial transplantation, 14,27 recipient age, 14,20,22,25,27,30 ventilatory status, 6,20 bilirubin level, 6,14,19,20,22,29,30 physical condition, 31 and intraoperative blood loss. 22,30 Interestingly, many patients in this study had isolated variables or poor outcomes (51% had bilirubin Ͼ10 mg/dL and 25% had serum creatinine Ͼ 2 mg/dL).…”

Section: Discussionmentioning

confidence: 99%

“…27 About half the patients were in the hospital at the time of reTX, with only a few in the ICU or on mechanical ventilation. Renal failure was not uncommon (10-20%) at reTX.…”

Section: Discussionmentioning

confidence: 99%

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Retransplantation for hepatitis C: Results of a U.S. multicenter retransplant study

et al. 2007

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It is widely perceived that outcomes are relatively poor following retransplantation (reTX) for recurrent of hepatitis C virus (HCV) infection. Transplant centers debate the utility of offering another liver to these patients. A U.S. study group was formed to retrospectively compare survival after reTX in patients with recurrent HCV (histologically proven) and those transplanted for other indications greater than 90 days after first transplantation, from 1996 to 2004. Patients were divided into 3 groups; group 1: HCV reTX (n ϭ 43), group 2: non-HCV reTX (n ϭ 73), and group 3: recurrent HCV but no reTX (n ϭ 156). They were predominantly male, Caucasian, with mean age of 47.2 yr. The commonest indications for non-HCV reTX were chronic rejection (36%), hepatic artery thrombosis (31%) and recurrent primary sclerosing cholangitis (17%). Duration of hospitalization, number of intensive care unit (ICU) days, and time interval from listing to transplantation or reTX were similar between reTX groups. The 1-yr and 3-yr survival rates after reTX were also similar for HCV reTX and non-HCV reTX groups (1 yr, 69% vs. 73%; 3 yr, 49% vs. 55%). Model for End-Stage Liver Disease (MELD) scores were not predictive of survival from reTX. However, with a MELD score of Ͼ30 in the non HCV group, survival was Ͻ50%. In the recurrent HCV not undergoing reTX group, 30% were reevaluated for reTX but only 15% were listed for reTX and the 3-yr survival was 47%. The most common reasons for not listing for reTX were recurrent HCV within 6 months (22%), fibrosing cholestatic hepatitis (19%), and renal dysfunction (9%). In conclusion, patients retransplanted for recurrent HCV had similar 1-yr and 3-yr survival when compared to patients undergoing reTX for other indications. MELD scores were not predictive of post-reTX survival. Survival was Ͻ50% in the non-HCV reTx group with MELD score of Ͼ30. Many patients with recurrent HCV are not considered for reTX and die from recurrent disease.

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Section: Discussionsupporting

confidence: 66%

Section: Discussioncontrasting

confidence: 60%

Section: Discussionmentioning

confidence: 99%

“…27 About half the patients were in the hospital at the time of reTX, with only a few in the ICU or on mechanical ventilation. Renal failure was not uncommon (10-20%) at reTX.…”

Section: Discussionmentioning

confidence: 99%

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Retransplantation for hepatitis C: Results of a U.S. multicenter retransplant study

et al. 2007

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“…Although the outcomes of retransplantation are inferior to those of primary LT by nearly 15%, [8][9][10][11][12] the results for retransplantation at 1 year have improved by 13%, whereas those for primary transplantation have improved by only 4.1%. The 1-and 5-year patient survival rates after primary transplantation, first retransplantation, and more than 2 transplants are 85%, 77%, and 72% and 73%, 63%, and 56%, respectively.…”

Section: Evidencementioning

confidence: 99%

Should we perform deceased donor liver transplantation after living donor liver transplantation has failed?

Greig¹,

Geier²,

D’Alessandro³

et al. 2011

Liver Transpl

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By asking whether we should perform deceased donor liver transplantation (DDLT) after living donor liver transplantation (LDLT) has failed, we appear to be questioning the generally accepted current practice of retransplantation for transplant failure. However, we will also consider in this analysis that LDLT may have been performed for patients whose tumors were beyond the local criteria for listing or increased priority on the deceased donor (DD) wait list (ie, the patients were not eligible for DDLT originally). To arrive at a recommendation, we will analyze the outcomes and ethical implications of retransplantation by considering the following 4 questions:1. Should we perform DDLT after the failure of DDLT? 2. Should we perform DDLT after the failure of LDLT in a patient without hepatocellular carcinoma (HCC)? 3. Should we perform DDLT after the failure of LDLT in a patient with HCC who fulfills the local criteria for listing and increased priority on the wait list? 4. Should we perform DDLT after the failure of LDLT in a patient with HCC who does not fulfill the local criteria for listing or increased priority on the wait list (ie, the patient failed to meet the criteria for DDLT originally)?With questions 1 to 3, we will consider the ethical foundation for the current practice of retransplantation for graft failure, and this discussion will serve as the basis for question 4, which is more controversial. MATERIALS AND METHODSElectronic literature searches were performed with the Ovid MEDLINE, Embase, and Cochrane databases in English, German, and French. The following key words were used in various combinations: liver transplant, live donor liver transplant, retransplant, rejection, loss, failure, survival, primary nonfunction, hepatic artery thrombosis, mortality, UNOS (ie, the United Network for Organ Sharing), and Eurotransplant. The MEDLINE search yielded 49 publications, the Embase search yielded 68, and the Cochrane search yielded 46. These were reviewed; the relevant studies were supplemented with additional studies, and they are referenced in the literature review.

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Long-term Analysis of Combined Liver and Kidney Transplantation at a Single Center

Ruiz

Kunitake

Wilkinson³

et al. 2006

Arch Surg

173

157

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To analyze use of combined liver and kidney transplantation (CLKT) for patients with chronic primary diseases of both organs and for patients with hepatorenal syndrome. Design: Retrospective case series. Setting: Multiorgan transplantation service in a large university medical center. Patients: A total of 98 patients underwent 99 CLKTs during a 16-year period; 76 had primary renal diseases, and 22 had hepatorenal syndrome. Patients receiving isolated liver and kidney transplants were analyzed for comparison. Main Outcome Measures: Patient and graft survival, rejection rates, and need for hemodialysis before and after transplantation.

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Analysis of Long-term Outcomes of 3200 Liver Transplantations Over Two Decades

Cited by 375 publications

References 42 publications

Retransplantation for hepatitis C: Results of a U.S. multicenter retransplant study

Retransplantation for hepatitis C: Results of a U.S. multicenter retransplant study

Should we perform deceased donor liver transplantation after living donor liver transplantation has failed?

Long-term Analysis of Combined Liver and Kidney Transplantation at a Single Center

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