Long-Term Survival After Retransplantation of the Liver

Abstract

ObjectiveThe authors determined the long-term outcome of patients undergoing hepatic retransplantation at their institution. Donor, operative, and recipient factors impacting on outcome as well as parameters of patient resource utilization were examined. Summary Background DataHepatic retransplantation provides the only available option for liver transplant recipients in whom an existing graft has failed. However, such patients are known to exhibit patient and graft survival after retransplantation that is inferior to that expected using the same organs in narive recipients. The critical shortage of donor organs and resultant prolonged patient waiting periods before transplantation prompted the authors to evaluate the results of a liberal policy of retransplantation and to examine the factors contributing to the inferior outcome observed in retransplanted patients. MethodsA total of 2053 liver transplants were performed at the UCLA Medical Center during a 13-year period from February 1, 1984, to October 1, 1996. A total of 356 retransplants were performed in 299 patients (retransplant rate = 17%). Multivariate regression analysis was performed to identify variables associated with survival. Additionally, a case-control comparison was performed between the last 150 retransplanted patients and 150 primarily transplanted patients who were matched for age and United Network of Organ Sharing (UNOS) status. Differences between these groups in donor, operative, and recipient variables were studied for their correlation with patient survival. Days of hospital and intensive care unit stay, and hospital charges incurred during the transplant admissions were compared for retransplanted patients and control patients.

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

“…MELD scores have been shown in other studies to predict posttransplantation survival. 9,19,24,25,28 In our study it was not predictive of survival in HCV patients partially due to low (3 yr) survival even in the moderate MELD score range. [20][21][22][23][24][25] Given the mean MELD score Ͼ25 at the time of evaluation for reTX, it is not surprising that these patients were often not offered a retransplant or could not survive long enough to get the organ they needed.…”

“…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).…”

“…This topic has been extensively reviewed and studied before; nevertheless, many predictive models have used elaborate mathematical formulas that are not easily used or have variables that are not available prior to the reTX. 19,20,28 In contrast to primary transplantation, the decision whether to retransplant a patient focuses on post-reTX survival. Whereas, pretransplant mortality (MELD score) is the principal driving force for primary transplantation.…”

“…Studies have used various models to predict postreTX outcomes, 19,20,28,31 but these models are not easily calculated and many of the variables are not available at the time of reTX evaluation (i.e., cold ischemia time, donor age, intraoperative blood loss). MELD scores have been shown in other studies to predict posttransplantation survival.…”

Retransplantation of the liver in adults: outcome and predictive factors for survival

“…Retransplantation of the liver (reOLT) after failure of the first graft is considered to carry a higher risk, with higher morbidity and lower survival than for the first transplantation [l, 2,3,4,5,6,7,8,9,10,111. In consideration of the often lower survival rate after reOLT, the increasing donor shortages, the pressure of increasing numbers of retransplant candidates on the waiting lists, and the higher costs of such procedures, it is important for one to evaluate the results of reOLT in order to compare the outcome.…”