Optimization of liver grafts in liver retransplantation: A European single-center experience

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doi:10.1016/j.surg.2008.06.029 Copyright © 2008 Mosby, Inc. All rights reserved.

Original Communication

Optimization of liver grafts in liver retransplantation: A European single-center experience

p Martí MDa, Ramón Charco MD, a, , Joana Ferrer MDa, Calatayud MDa, Antoni Rimola MDa, Miquel Navasa MDa, Constantino Fondevila MDa, p Fuster MDa and García-Valdecasas MDa

aLiver Transplant Unit, Institut Clínic de Malalties Digestives i Metabolisme, Hospital Clínic i Provincial, CIBERehd, Barcelona, Spain

Accepted 15 June 2008.

Available online 3 September 2008.

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Background

Liver retransplantation (ReLT) is the only therapeutic option that offers a chance at long-term survival when a liver graft fails. Careful analysis of the results and potential benefits is needed to justify its role in the current era of donor shortage and economical concerns. We reviewed all retransplants performed in our hospital and tried to determine if there is a high risk group of patients in whom its use would be contraindicated.

Methods

Between June 1988 and January 2006, 1226 liver transplants were performed in 1118 patients at our institution. Among them, 108 retransplants (8.8%) were performed in 98 patients. Preoperative, intraoperative, and postoperative data were gathered from our prospectively collected liver transplant database. The entire series of patients was divided between two periods of equal duration and patients were also classified according to the interval between retransplantation and the previous transplant.

Results

Concerning indications, only chronic rejection was a more frequent etiology in the first period versus the second period. When comparing first and second periods, 1-, 5-, and 10-year graft survival was 66%, 45%, and 40% and 76%, 69%, and 69%, respectively (P = .014). No significant differences in post-ReLT survival were found when the indication was HCV recurrence versus other non-urgent causes (1-, 5-, and 10-year graft survival: 70%, 57%, and 57% vs 72%, 50%, and 45%). According to the UNOS Rosen risk score, patients in the low-risk group showed significantly greater survival with respect to patients in the high-risk group though 5-year survival in the high-risk group was still greater than 50%.

Conclusions

ReLT indications have changed over time, with better results being achieved in more recent years. Candidate selection in elective ReLT is critical to improve the results, though current criteria do not allow for the identification of a single patient subset in which ReLT would be contraindicated.

Article Outline

Patients and methods

ReLT criteria at the Hospital Clinic Liver grafts Retransplant data Statistical analysis

Results

Transplant era Transplant urgency Transplant survival

Discussion References

Fig 1. Retransplantation actuarial graft survival according to periods.

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