Outcome of liver retransplantation in children

Abstract

Irreversible liver graft failure is a life-threatening complication. We reviewed the first 200 pediatric liver transplantations in Birmingham. Forty-one children developed primary graft failure, 9 of whom developed secondary graft failure. The main indications for graft failure were primary nonfunction (PRNF; 8 patients), vascular complications (VASC; 23 patients), and chronic rejection (CHRE; 19 patients). Thirty-two children underwent retransplantation (ReTx) (21 children received reduced grafts; 11 children, whole hepatic grafts). Patient survival was significantly worse for retransplant recipients compared with children receiving a single graft (63% v 76.5% actuarial patient survival at 1 year; P F .05). Primary graft 1-year actuarial survival was 74% in first grafts compared with 47% for regrafts (P F .05), but improved with time. The graft 1-year survival rate was 55% for whole grafts and 45% for reduced and/or split grafts in the first 100 grafts compared with 83% and 66% in the second 100 grafts, respectively (P F .01). Emergency ReTx within a month of transplantation was associated with more complications and a worse outcome (1-year survival rate, 37%) compared with patients who underwent ReTx later (1-year survival rate, 72%; P F .01). The incidence of primary graft failure decreased from 33% in the first 100 grafts to 16% in the second 100 grafts (P F .01), as did the incidence of PRNF, which decreased from 8% to 0% (P F .05). Although the rates of graft failure from VASC decreased from 15% to 8% (P ‫؍‬ .2) and CHRE decreased from 11% to 8% (P ‫؍‬ .6), neither reached statistical significance. The improved results overall are because of advances in surgical techniques, intensive care management, and graft preservation and refinements in immunosuppression. We conclude that ReTx for a child with primary graft failure is justified.

Liver Retransplantation in Children: A SPLIT Database Analysis of Outcome and Predictive Factors for Survival

“…Except in the settings of extrahepatic sources of sepsis, disseminated malignancies and severe, irreversible neurologic injuries which are absolute contraindications to liver retransplantation (rLT), the approach of most pediatric LT programs is to offer the option of rLT to children with documented allograft failure. In an era when demand for livers far exceeds available supply, the judicious use of limited organs requires continual reevaluation of both indications for and outcomes after LT. To date, multiple single center experiences report 1-year patient survival rates of up to 77% after pediatric rLT (2)(3)(4)(5)(6)(7)(8), similar to results of rLT reported in adults (7,(9)(10)(11)(12)(13)(14)(15)(16), but inferior to the survival of children after primary LT. As single center experiences on the outcomes of pediatric rLT are subject to a number of limitations, we herein present the outcomes and identify prognostic factors affecting survival of children from the SPLIT database who have undergone rLT.…”

Progressive histological damage in liver allografts following pediatric liver transplantation

“…The indications for transplantation, patient and graft survival, re-transplantation rate, incidence of acute rejection, and viral infections and use of innovative surgical approaches are similar in our center to contemporaneous reports. 34,35,37,39,40,42 …”

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.…”