Have We Changed the Liver Retransplantation Survival?

Bellido, C. Bernal; Martínez, J. M. Álamo; Artacho, G. Suárez; Gómez, Luis Miguel Marín; Díez-Canedo, J. Serrano; Barrera-Pulido, L.; Acevedo, Juan Manuel Pascasio; Ruiz, J Padillo; Bravo, Miguel Ángel Gómez

doi:10.1016/j.transproceed.2012.05.010

Cited by 12 publications

(4 citation statements)

References 16 publications

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“…Several previous studies of retransplantation conducted in single centers as well as using UNOS and SPLIT databases have reported protective and risk factors . A multivariate analysis of the UNOS database described number of retransplants, race, hospitalization in the ICU, weight, creatinine levels, bilirubin levels, donor age, and cold ischemia time as risk factors in retransplantation .…”

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confidence: 99%

“…A study using SPLIT retransplantation data found associations between survival at two yrs and donor age, use of a technical variant allograft, and INR at retransplant . Single‐center studies have also reported associations between survival and patient age, presence of cholestasis, congenital abnormalities, pretransplant ALT, donor age, donor cardiac death, regional vs. national allocation, and percent blood transfusion during transplant . A prognostic scoring tool constructed by Davis et al includes life support at retransplant, split liver graft, cholestasis or paucity of bile ducts, and congenital abnormalities as risk factors and older patient age and an indication of acute rejection as protective factors for retransplant patients.…”

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Long‐term outcomes and predictors in pediatric liver retransplantation

Dreyzin

Lunz

Venkat

et al. 2015

Pediatric Transplantation

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Historically, 9-29% of pediatric liver transplant recipients have required retransplantation. Although outcomes have improved over the last decade, currently published patient and graft survival remain lower after retransplant than after primary transplant. Data from liver retransplantation recipients at our institution between 1991 and 2013 were retrospectively reviewed. Kaplan-Meier estimates were used to depict patient and graft survival. Predictors of survival were analyzed using a series of Cox proportional hazards models. Predictors were analyzed separately for patients who had "early" (≤ 30 days after primary transplant) and "late" retransplants. Eighty-four patients underwent retransplant at a median time of 241 days. Sixty percent had late retransplants. At one, five, and 10 yr, actuarial patient and graft survival were 73%/71%, 66%/63%, and 58%/53%, respectively. Since 2002, patient and graft survival improved to 86%/86% at one yr and 93%/87% at five yr. While operative complications were a common cause of death after earlier retransplants, since 2002, infection has been the only cause of death. Significant morbidities at five-yr follow-up include renal dysfunction (15%), diabetes (13%), hypertension (26%), chronic rejection (7%), and PTLD (2%). Current survival after pediatric liver retransplantation has improved significantly, but long-term immunosuppressant morbidity remains an opportunity for improvement.

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confidence: 99%

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Long‐term outcomes and predictors in pediatric liver retransplantation

Dreyzin

Lunz

Venkat

et al. 2015

Pediatric Transplantation

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“…Multiple studies have reported that the retransplant interval (the time interval between primary LT and reLT) has a significant effect on post-reLT outcomes (2, 7, 32, 34-36). In particular, many studies have reported that a retransplant interval of 0-7 or 0-10 days yields different survival rates from retransplant intervals of 7-30 or 10-30 days (5,7,(37)(38)(39)(40). However, most of the reports identified in the primary meta-analysis used different time cut-offs, making direct comparisons of HRs difficult.…”

Section: Meta-analysis Of the Effects Of The Retransplant Intervalmentioning

confidence: 99%

Factors affecting survival after liver retransplantation: a systematic review and meta-analysis

et al. 2023

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BackgroundLiver retransplantation (reLT) has historically had inferior survival relative to primary liver transplant (LT). To improve outcomes after reLT, researchers have identified factors predicting overall (OS) and/or graft survival (GS) after reLT. This systematic review and random effects meta-analysis sought to summarize this literature to elucidate the strongest independent predictors of post-reLT.MethodsA systematic review was conducted to identify manuscripts reporting factors affecting survival in multivariable Cox proportional hazards analyses. Papers with overlapping cohorts were excluded.ResultsAll 25 included studies were retrospective, and 15 (60%) were single-center studies. Patients on pre-transplant ventilation (HR, 3.11; 95% CI, 1.56–6.20; p = 0.001) and with high serum creatinine (HR, 1.46; 95% CI, 1.15–1.87; p = 0.002) had the highest mortality risk after reLT. Recipient age, Model for End-Stage Liver Disease score, donor age, and cold ischemia time >12 h also conferred a significant risk of post-reLT death (all p < 0.05). Factors affecting GS included donor age and retransplant interval (the time between LT and reLT; both p < 0.05). OS is significantly higher when the retransplant interval is ≤7 days relative to 8–30 days (p = 0.04).ConclusionsThe meta-analysis was complicated by papers utilizing non-standardized cut-off values to group variables, which made between-study comparisons difficult. However, it did identify 7 variables that significantly impact survival after reLT, which could stimulate future research into improving post-reLT outcomes.

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“…Early super-urgent liver re-transplantation is associated with a mortality between 25 and 35% ( 4 , 9 ). In addition, there is a further mortality related to the lack of a suitable donor liver becoming available in an acceptable timeframe.…”

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confidence: 99%

Seventh Day Syndrome Revisited: Early Recognition of the Clinical Syndrome and an Evolving Understanding of Its Etiology

et al. 2022

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BackgroundUnexplained acute failure of an initially functioning liver graft early post-transplant has been described as Seventh-Day Syndrome (7DS). The aims of this study were to describe the clinical syndrome in detail based on an institutional case series and literature review.MethodsA retrospective review of adult patients that underwent deceased donor liver transplantation at our institution between January 2010 and 2020 was performed to identify patients that developed 7DS. Relevant clinical variables were obtained from medical records. Existing cases in the literature were identified by a systematic literature search according to PRISMA guidelines. Pooled analysis was used to describe the incidence, retransplantation, and mortality rate. Histological findings from institutional and published literature cases were collected and appraised.ResultsSix of 1,907 liver transplantations at our institution (0.3%) developed 7DS. Seven case series, describing 42 patients with 7DS, and two single case reports were identified from literature review. Pooled incidence of 7DS was low (2.1%, 95%CI: 0.7–3.9%) and associated with high mortality (74.8%, 95%CI: 49.2–94.6%). Retransplantation was performed in 23/42 (55%) patients and 4/23 (17%) survived. Review of histology showed frequent intrahepatic thrombi and arteritis. Rejection, with features of potential antibody mediated rejection, often preceded or accompanied progressive zonal coagulative necrosis and hemorrhage.Conclusions7DS is a rare clinical syndrome after liver transplantation and associated with high mortality. Antibody-mediated rejection, as suggested in early reports, is likely to be involved in the pathogenesis. Early recognition would allow rapid clinical diagnostics and expedited decisions, such as treatment of AMR if diagnosed or early retransplantation.

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Have We Changed the Liver Retransplantation Survival?

Cited by 12 publications

References 16 publications

Long‐term outcomes and predictors in pediatric liver retransplantation

Long‐term outcomes and predictors in pediatric liver retransplantation

Factors affecting survival after liver retransplantation: a systematic review and meta-analysis

Seventh Day Syndrome Revisited: Early Recognition of the Clinical Syndrome and an Evolving Understanding of Its Etiology

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