Late orthotopic liver retransplant: indications and survival

Clemente, G.; F, Durán; Loinaz, Carmelo; Casanovas, Teresa; Rimola, Antoni; Jara, Paloma; Cuervas-Mons, Valentín; Ja, Pons; Margarit, C; Prieto, Martín; Mata, Mario de la; Bárcena, Rafael; Casafont, F.; Suarez, Félipe; Ja, Quiroga; Varó, Evaristo; Gonzalez, A.M.; Maldonado, Juan; Mj, Suárez García

doi:10.1016/s0041-1345(98)01732-1

Cited by 7 publications

(3 citation statements)

References 13 publications

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“…14 In general, re-OLT has a lower survival rate than primary OLT. [15][16][17] In small studies, patient survival after re-OLT for HCV was not different compared with re-OLT for other causes. 1,3,12,18 Conversely, several other studies suggested that survival after re-OLT for HCV is significantly worse than that for non-HCV-related indications.…”

mentioning

confidence: 98%

Poor survival after liver retransplantation: Is hepatitis C to blame?

Watt

Lyden

McCashland

2003

Liver Transplantation

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Data from 1990 to 1996 suggest that the prevalence of hepatitis C virus (HCV) infection in repeated orthotopic liver transplantation (re-OLT) is increasing, and patient survival may be worse. Aims of the study are to: (1) assess the prevalence of HCV in re-OLT, (2) compare survival between primary OLT and re-OLT for HCV versus non-HCV diseases, and (3) evaluate Model for End-Stage Liver Disease (MELD) scores in re-OLT. The United Network for Organ Sharing database for adult patients undergoing primary OLT or re-OLT from January 1996 to June 2002 was analyzed. Patients with malignancy or those who underwent re-OLT within 30 days of primary OLT were excluded. A total of 22,120 primary OLTs and 2,129 reOLTs were performed. HCV was noted in 9,564 primary OLTs (43.2%) and 899 re-OLTs (42.2%). Overall 1, 3, and 5-year patient survival rates were 86%, 79%, and 73% for primary OLT, but 67%, 56%, and 52% for re-OLT (P < .001). Survival rates of patients with HCV at 1, 3, and 5 years were 86%, 76%, and 68% for primary OLT and 61%, 50%, and 45% for re-OLT (P < .001). Survival was less for patients with HCV compared with those with autoimmune hepatitis (AIH) and hepatitis B for re-OLT (P < .01). However, survival after re-OLT was no different for those with HCV than for those with all other causes. MELD scores between 11 and 20 were the most common for re-OLT. A marked decreased in survival was noted in all patients who underwent re-OLT with MELD scores greater than 25. HCV prevalence in OLT has reached a plateau in recent years. Survival after re-OLT is inferior to that for primary OLT, but re-OLT survival appears to have improved. Survival after re-OLT is lower in patients with HCV compared with those with AIH and hepatitis B, but no different than for those with most other liver diseases. Survival appeared worse in patients who underwent re-OLT with a MELD score greater than 25. (Liver Transpl 2003;9:1019-1024.) R ecurrence of hepatitis C virus (HCV) after orthotopic liver transplantation (OLT) is almost universal. [1][2][3][4] Recent data suggest that in approximately 20% of HCV-related transplantations, allograft cirrhosis develops within 5 years. 5-9 HCV-related re-OLT increased significantly throughout the early 1990s, 10 but there are no recent prevalence data to show if this trend continues.Patient survival after primary OLT for HCV infection throughout the 1990s was similar to that for most other indications for OLT. [11][12][13] However, a recent study by Forman et al 14 showed an increased rate of death and allograft failure in HCV-positive compared with HCV-negative transplant recipients. 14 In general, re-OLT has a lower survival rate than primary OLT. [15][16][17] In small studies, patient survival after re-OLT for HCV was not different compared with re-OLT for other causes. 1,3,12,18 Conversely, several other studies suggested that survival after re-OLT for HCV is significantly worse than that for non-HCV-related indications. 10,[19][20][21] These studies also suggested that survival is worse in patients wit...

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confidence: 98%

Poor survival after liver retransplantation: Is hepatitis C to blame?

Watt

Lyden

McCashland

2003

Liver Transplantation

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“…The presence of persistent dysfunction or new‐onset neurological dysfunction has many implications for the patient. First, patients with central nervous system complications tend to have a longer hospital stay ( 72,73 ) associated with higher rates of infections, ( 78,79 ) which eventually could translate to higher rates of retransplantation, although more recent data are required. ( 73,79 ) Second, based on the underlying etiology for the cognitive dysfunction, patients could take longer to demonstrate self‐efficacy, ( 80 ) although this does not always translate to loss of employment and income.…”

Section: Course Of Neurological Changes Post–liver Transplantation and Managementmentioning

confidence: 99%

“…The presence of persistent dysfunction or new-onset neurological dysfunction has many implications for the patient. First, patients with central nervous system complications tend to have a longer hospital stay (72,73) associated with higher rates of infections, (78,79) which eventually could translate to higher rates of retransplantation, (2) More accurately captures burden of HE than Grade 3 or 4 HE at time of listing (2) Need to ensure adherence and prescription of medications for HE prevention Could be a pragmatic approach for patients with multiple admissions without any correctable cause to improve their life expectancy and preserve brain function (109) (3) Need to ensure spontaneous portosystemic shunts are embolized, if possible Cognitive testing Multicenter studies show these add points to the biological MELD score (68) (2) Norm based (2) Variable over time Patient-reported outcomes…”

Section: Post-liver Transplantation Cognitive Dysfunctionmentioning

confidence: 99%

Hepatic Encephalopathy and Liver Transplantation: The Past, Present, and Future Toward Equitable Access

Acharya

Bajaj

2021

Liver Transpl

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Cirrhosis is a debilitating chronic disease with high morbidity and mortality, with the only real cure being liver transplantation (LT). Currently, we allocate organs for transplantation based on the Model for End‐Stage Liver Disease–Sodium (MELD‐Na) score that does not account for hepatic encephalopathy (HE). HE affects patients, families, and the health care system because of high rates of recurrence and major readmission burden. Moreover, HE casts a long shadow even after LT. Accounting for HE and incorporating it into the current allocation system has many proponents, but the framework to do this is currently lacking because of differences in consensus or in operationalization parameters. We review the latest evidence of the burden of HE, management of HE before and after LT, and evaluate pros and cons of several methods of diagnosing HE objectively to ensure early and equitable access to LT in this underserved population.

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