Repeat orthotopic liver transplantation in the 1990s: is it justified?

Abstract

Repeat orthotopic liver transplantation (ReOLT) is controversial because of limited donor organ availability and increasing health care costs. The purpose of this study is to analyse and compare the outcome of reOLT in the 1990s and the 1980s. Prospective data of 1077 adult OLT from the Liver Unit database were used for the study. The log-rank test was used for statistical analysis. Between January 1982 and December 1996, a total of 1077 adult OLTs were performed including 107 reOLTs. The proportion of retransplants decreased from 13 % in the 1980s to 9 Yo in the 1990s. There was a significant improvement in outcome; the overall 1 -year graft and patient survival for reOLT was 60 YO and 74 % in the 1990s compared to 29 Yo (P < 0.0001) and 51 % ( P < 0.0001) in the 1980s. In the second half of the study between January 1990 and December 1996,732 adult OLTs were undertaken including 70 (9 YO ) reOLTs which consisted of 63 second. 7 third and 1 fourth grafts. The main indications for retransplantation were chronic rejection (31 Y O ) , hepatic artery thrombosis (30 YO ), primary non-function (16 Yo ), ischaemic injury (1 1 YO ), recurrent disease (6 YO ) and biliary complications (6 YO ). During this period, the l-year graft survival for all reOLTs was significantly lower than for primary OLTs (67 Yo vs 78 Yo, P < 0.001 ). The timing of reOLT was found to be associated with graft survival; 1-year graft survival for early reOLT (< 30 days) was SO Yo compared to 73 YO for late reOLT ( P < 0.001 ). The worse outcome associated with early reOLT is explained by the poor preoperative medical condition of patients who were retransplanted from intensive care. Subgroup analysis of indications for reOLT revealed 1-year graft survival of 81 YO for late vascular complications, 75 Yo for early vascular complications, 69 O/O for chronic rejection and 30 YO for primary non-function. One-year graft survival rates for third and fourth grafts were 42 Yo and 0 Yo, respectively. Graft survival and resource utilisation in patients who received a late regraft for the first time is now comparable to that for primary OLT. The favourable overall results should not preclude this group of patients from consideration for re-0 LT.

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.…”

“…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. From the literature, different predictive factors for survival after reOLT are known [4,5,6,7,12,13,14,15,16,17, 181, but they were not always acquired by multivariate analysis [4,6,7,12,13,141. The present study evaluates the results of reOLT in adult patients at our institution, with special emphasis on outcome and independent predictive factors for survival.…”

Retransplantation of liver: Primary graft nonfunction and hepatitis C virus are associated with worse outcome

“…1 Approximately 15% of patients who receive a transplant will require liver retransplantation (re-LT) for a variety of reasons, including primary graft nonfunction (PGNF), chronic rejection, and disease recurrence. 2,3 It has been shown that the outcome of re-LT is worse than that of primary liver transplantation (PLT; first transplantation). 3,4 However, it is unclear whether the poor outcome is a reflection of the underlying cause of allograft failure requiring re-LT or caused by other confounding variables.…”

“…2,3 It has been shown that the outcome of re-LT is worse than that of primary liver transplantation (PLT; first transplantation). 3,4 However, it is unclear whether the poor outcome is a reflection of the underlying cause of allograft failure requiring re-LT or caused by other confounding variables. Many factors, including age, race, cause of liver disease, United Network for Organ Sharing (UNOS) status, creatinine level, diabetes, obesity, hypertension, and heart disease, influence posttransplantation survival.…”

“…11,12 The appropriateness of re-LT in these patients has been questioned on the basis of ethical and financial grounds, but to have a serious debate, it is important to understand the risk-adjusted outcome of re-LT in a large patient population and identify risk factors that determine poor outcome. 3,13 The objective of our study is to analyze the UNOS database to determine outcome in patients who undergo re-LT after adjusting for other confounding variables and, more specifically, compare the outcome based on indication (PGNF versus others) and cause of liver disease (HCV versus others).…”