Hepatic retransplantation in cholestatic liver disease: impact of the interval to retransplantation on survival and resource utilization.
The aim of our study was to quantitatively assess the impact of hepatic retransplantation on patient and graft survival and resource utilization. We studied patients undergoing hepatic retransplantation among 447 transplant recipients with primary biliary cirrhosis (PBC) and primary sclerosing cholangitis (PSC) at 3 transplantation centers. Cox proportional hazards regression analysis was used for survival analysis. Measures of resource utilization included the duration of hospitalization, length of stay in the intensive care unit, and the duration of transplantation surgery. Forty-six (10.3%) patients received 2 or more grafts during the follow-up period (median, 2.8 years). Patients who underwent retransplantation had a 3.8-fold increase in the risk of death compared with those without retransplantation (P <.01). Retransplantation after an interval of greater than 30 days from the primary graft was associated with a 6.7-fold increase in the risk of death (P <.01). The survival following retransplantations performed 30 days or earlier was similar to primary transplantations. Resource utilization was higher in patients who underwent multiple consecutive transplantations, even after adjustment for the number of grafts during the hospitalization. Among cholestatic liver disease patients, poor survival following hepatic retransplantation is attributed to late retransplantations, namely those performed more than 30 days after the initial transplantation. While efforts must be made to improve the outcome following retransplantation, a more critical evaluation may be warranted for late retransplantation candidates.
Division of Gastroenterology and Hepatology, Mayo Clinic and Mayo Foundation, Rochester, MN, USA. kim.wooug@mayo.edu.edu
W R
WR
Kim
R H
RH
Wiesner
J J
JJ
Poterucha
T M
TM
Therneau
M
M
Malinchoc
J T
JT
Benson
J S
JS
Crippin
G B
GB
Klintmalm
J
J
Rakela
T E
TE
Starzl
R A
RA
Krom
R W
RW
Evans
E R
ER
Dickson
D000328:Adult; D000368:Aged; D015209:Cholangitis, Sclerosing / Q000401:mortality / Q000601:surgery*; D005260:Female; D006801:Humans; D008105:Liver Cirrhosis, Biliary / Q000401:mortality / Q000601:surgery*; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012086:Reoperation; D015996:Survival Rate; D013997:Time Factors