An outcome comparison between primary liver transplantation and retransplantation based on the pretransplant MELD score.
Survival after liver retransplantation (RLTX) is worse than after primary liver transplantation (LTX). We studied retrospectively the 2-year outcome in 44 patients who received RLTX more than 30 days after the primary transplant and in 669 after LTX performed between December 1993 and October 1999, focusing on the relation between the model for end-stage liver disease (MELD) score immediately pretransplant and post-transplant survival. A 2-year survival for RLTX was inferior to LTX (65.9% vs. 82.9%, P < or = 0.01). This difference was greatest with MELD scores < 25; survival within 2 years remained 11.3-18.2% less for RLTX than for LTX (6 months, P = 0.002; 12 months, P = 0.029, 24 months, P = 0.123). Mortality was mainly related to early vascular complications and sepsis. Two-year survival after RLTX was 81.8% if RLTX occurred < 2 years after LTX and 50% if the interval between LTX and RLTX was > 2 years (P < 0.05). MELD scores were similar in 2-year survivors and nonsurvivors after late RLTX (P = 0.82). Late RLTX is marked by poor survival regardless of the pretransplant MELD score. The MELD-based allocation system may not benefit patients who undergo retransplantation.
Transplant Services, Baylor University Medical Center, Dallas, TX 75204, USA.
Nicholas
N
Onaca
Marlon F
MF
Levy
Takehisa
T
Ueno
Adrian P
AP
Martin
Edmund Q
EQ
Sanchez
Srinath
S
Chinnakotla
Henry B
HB
Randall
Sherfield
S
Dawson
Robert M
RM
Goldstein
Gary L
GL
Davis
Goran B
GB
Klintmalm
D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D017093:Liver Failure / Q000401:mortality* / Q000601:surgery*; D016031:Liver Transplantation / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D008954:Models, Biological; D017063:Outcome Assessment, Health Care; D012086:Reoperation; D015996:Survival Rate