title: Risk factors for death following liver retransplantation.
abstract: OBJECTIVE
  Our goal was to retrospectively analyze graft loss and mortality risk factors using multi-centre data on liver retransplantation.
  
  
  METHODS
  Between 1991-1995, 640 patients underwent 718 liver transplants in Barcelona. Mean age of the 74 patients receiving a second transplant was 47.6 years (range 19-65). Causes of retransplantation were immunologic in 26 patients (35.1%), technical in 23 (31.1%), primary dysfunction in 12 (16.2%), recurrent original disease in 7 (9.5%), and other causes in 6 (8.1%). Mean time between first and second transplant was less than 7 days in 20 patients (27%), between 8 and 30 days in 4 (5.4%) and more than 30 days in 50 patients (67.6%). Recipient, donor, and operative variables were analyzed using univariate (Kaplan-Meier curves) and multivariate techniques (Cox regression) to identify risk factors.
  
  
  RESULTS
  Retransplant patient survival at 1 and 5 years was 60.8% and 49.5%, respectively, compared to 75.6% and 64.8% in a series of 640 first transplant patients. Mortality risk factors identified by multivariate analysis were bilirubin >12 mg/dL (RR 2.3; P=.010), recipient age (RR increase 0.04 for each additional year; P=.02), cause for retransplant (immunologic RR 4.01, technical RR 2.7 and other causes RR 6.9; compared to primary dysfunction RR 1; P=.020). Urea >54 mg/dL (0.02) and multiple transfusions >15 units red blood cells (0.001) were only significant in the univariate analysis.
  
  
  CONCLUSIONS
  In our experience, retransplantation for primary dysfunction is the setting that has the best prognosis. Of the other causes, retransplantation should be performed before the total bilirubin reaches >12 mg/dL or before the appearance of variables indicative of severe renal insufficiency.
authors.affiliation: Hospital Vall d'Hebrón, Barcelona, Spain. bilbao@hg.vhebron.es
authors.forename: I
authors.initials: I
authors.lastname: Bilbao
authors.forename: J
authors.initials: J
authors.lastname: Figueras
authors.forename: L
authors.initials: L
authors.lastname: Grande
authors.forename: M
authors.initials: M
authors.lastname: Clèries
authors.forename: E
authors.initials: E
authors.lastname: Jaurrieta
authors.forename: J
authors.initials: J
authors.lastname: Visa
authors.forename: C
authors.initials: C
authors.lastname: Margarit
mesh_terms: D000328:Adult; D000368:Aged; D000410:Alanine Transaminase / Q000097:blood; D000704:Analysis of Variance; D001219:Aspartate Aminotransferases / Q000097:blood; D001663:Bilirubin / Q000097:blood; D005260:Female; D006801:Humans; D016031:Liver Transplantation / Q000401:mortality* / Q000502:physiology; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D012086:Reoperation / Q000401:mortality*; D012189:Retrospective Studies; D012307:Risk Factors; D016019:Survival Analysis; D013997:Time Factors
chemical_list: D001219:Aspartate Aminotransferases; D000410:Alanine Transaminase; D001663:Bilirubin