Liver retransplantation in adults: a single-centre, 25-year experience

• Published in: HPB (Oxford, England) England), 2010-04, Vol.12 (3), p.217-224
• Main Authors: Marudanayagam, Ravi, Shanmugam, Vivekanandan, Sandhu, Bynvant, Gunson, Bridget K., Mirza, Darius F., Mayer, David, Buckels, John, Bramhall, Simon R.
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Age Factors; Aged; Graft Rejection; Hepatic Artery; Hepatitis, Autoimmune - surgery; Humans; liver retransplantation; Liver Transplantation - mortality; Middle Aged; Original; Postoperative Complications - surgery; Prognosis; Reoperation - statistics & numerical data; Retrospective Studies; Survival Rate; Thrombosis - surgery; Tissue Donors
• ISSN: 1365-182X; 1477-2574
• DOI: 10.1111/j.1477-2574.2010.00162.x

Retransplantation is the only form of treatment for patients with irreversible graft failure. The aim of this study was to analyse a single centre's experience of the indications for and outcomes of retransplantation. A total of 196 patients who underwent liver retransplantation using 225 grafts, between January 1982 and July 2007, were included in the study. The following parameters were analysed: patient demographics; primary diagnosis; distribution of retransplantation over different time periods; indications for retransplantation; time interval to retransplantation, and overall patient and graft survival. Of the 2437 primary orthotopic liver transplantations, 196 patients (8%) required a first regraft, 23 patients (1%) a second regraft and six patients (0.25%) a third regraft. Autoimmune hepatitis was the most common primary diagnosis for which retransplantation was required (12.7% of primary transplantations). The retransplantation rate declined from 12% at the beginning of our programme to 7.6% at the end of the study period. The most common indication for retransplantation was hepatic artery thrombosis (31.6%). Nearly two-thirds of the retransplantations were performed within 6 months of the primary transplantation. The 1-, 3-, 5- and 10-year patient survival rates following first retransplantation were 66%, 61%, 57% and 47%, respectively. Five-year survival after second retransplantation was 40%. None of the patients have yet survived 3 years after a third regraft. Donor age of ≤55 years and a MELD (Model for End-stage Liver Disease) score of ≤23 were associated with better outcome following retransplantation. First retransplantation was associated with good longterm survival. There was no survival benefit following second and third retransplantations. A MELD score of ≤23 and donor age of ≤55 years correlated with better outcome following retransplantation.